Abstract
Knowledge on long-term evolution of upper limb function in children with unilateral cerebral palsy (CP) is scarce. The objective was to report the five-year evolution in upper limb function and identify factors influencing time trends. Eighty-one children (mean age 9 y and 11 mo, SD 3 y and 3 mo) were assessed at baseline with follow-up after 6 months, 1, and 5 years. Passive range of motion (PROM), tone, muscle, and grip strength were assessed. Activity measurements included Melbourne Assessment, Jebsen-Taylor test, Assisting Hand Assessment (AHA), and ABILHAND-Kids. At 5-year follow-up, PROM (p < 0.001) and AHA scores (p < 0.001) decreased, whereas an improvement was seen for grip strength (p < 0.001), Melbourne Assessment (p = 0.003), Jebsen-Taylor test (p < 0.001), and ABILHAND-Kids (p < 0.001). Age influenced the evolution of AHA scores (p = 0.003), with younger children being stable over time, but from 9 years onward, children experienced a decrease in bimanual performance. Manual Ability Classification System (MACS) levels also affected the evolution of AHA scores (p = 0.02), with stable scores in MACS I and deterioration in MACS II and III. In conclusion, over 5 years, children with unilateral CP develop more limitations in PROM, and although capacity measures improve, the spontaneous use of the impaired limb in bimanual tasks becomes less effective after the age of 9 years.
Highlights
Becoming independent in activities of daily living requires—amongst others—a smooth coordination between both hands
Holmefur et al and Nordstrand et al demonstrated improvements in the spontaneous use of the impaired hand during bimanual tasks in children aged between 18 months and 8 years or 12 years, respectively, who were followed over a period of 4.5 or 6 years, respectively [2, 3]
According to the Manual Ability Classification System (MACS), 29 (36%) children were classified as level I, 36 (44%) as level II, and 16 (20%) as level III
Summary
Becoming independent in activities of daily living requires—amongst others—a smooth coordination between both hands. In children with unilateral cerebral palsy (CP), the occurrence of an early brain lesion elicits sensorimotor impairments in the contralateral upper limb. Such impairments compromise the development of upper limb function, which in turn restrains bimanual coordination [1]. Insights into the long-term evolution of upper limb function in these children are indispensable to inform parents about these restraints and to steer goal setting and treatment selection. It may aid in distinguishing whether changes in upper limb function following an intervention program are attributable to therapy response or to natural change over time. Two other studies did not find changes in bimanual performance
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