Bimanual Fine Motor Function Research Articles

Tractography of sensorimotor pathways in dyskinetic cerebral palsy: Association with motor function.

Neuroimaging studies of dyskinetic cerebral palsy (CP) are scarce and the neuropathological underpinnings are not fully understood. We delineated the corticospinal tract (CST) and cortico-striatal-thalamocortical (CSTC) pathways with probabilistic tractography to assess their (1) integrity and (2) association with motor functioning in people with dyskinetic CP. Diffusion weighted magnetic resonance images were obtained for 33 individuals with dyskinetic CP and 33 controls. Fractional anisotropy (FA) and mean diffusivity (MD) for the CST and the CSTC pathways were compared between groups. Correlation analyses were performed between tensor metric values and motor function scores of participants with dyskinetic CP as assessed by the Gross Motor Function Classification System (GMFCS), the Bimanual Fine Motor Function (BFMF), and the Manual Ability Classification System (MACS). White matter integrity in both the CST and the CSTC pathways was reduced in people with dyskinetic CP. The GMFCS, MACS and, less commonly, the BFMF were associated with FA and, particularly, MD in most portions of these pathways. The present study advances our understanding of the involvement of white matter microstructure in sensorimotor pathways and its relationship with motor impairment in people with dyskinetic CP. Our results are consistent with well-described relationships between upper limb function and white matter integrity in the CST and CSTC pathways in other forms of CP. This knowledge may ultimately help prognosis and therapeutic programmes.

Association Between Gross Motor Function and Manual Ability in Children with Spastic Cerebral Palsy

Background: Cerebral Palsy (CP) is a complex neurological condition that significantly impacts a child's motor abilities. Understanding the relationship between gross motor function and manual ability in children with CP, particularly spastic diplegia, is crucial for developing effective treatment strategies. Objective: This study aimed to investigate the association between Gross Motor Function Classification System (GMFCS) levels and Manual Ability Classification System (MACS) as well as Bimanual Fine Motor Function (BFMF) in children with spastic diplegic CP. Methods: A cross-sectional study was conducted involving 186 children aged 6-12 years with Diplegic CP, using convenience sampling. The GMFCS, MACS, and BFMF were employed to assess gross motor function, manual ability, and bimanual fine motor function, respectively. Data analysis was performed using SPSS 26.0, focusing on descriptive statistics and correlation coefficients. Results: The mean age of participants was 8.35 years (SD = 1.998). The study comprised 57% male and 43% female participants. GMFCS levels distribution showed that the most common level was IV (31.2%), followed by levels III (19.4%) and V (18.8%). A strong correlation was observed between GMFCS and MACS (r = .752, p < 0.001) and a moderate to strong correlation between GMFCS and BFMF (r = .618, p < 0.001). Conclusion: The study concluded that gross motor function significantly influences manual ability in children with spastic diplegic CP. Higher GMFCS levels were associated with more severe impairments in manual ability and bimanual fine motor function.

Asymmetric involvement of hands: Psychometric properties of the Turkish version of the Bimanual Fine Motor Function 2.0 classification in children with cerebral palsy

BackgroundManual functions affect more than a half of children with Cerebral palsy (CP). Asymmetric involvement of hands may also affect unilateral and bilateral activities of daily life. The Bimanual Fine Motor Function version 2.0 (BFMF-2.0) is a unique functional classification that categorizes the capacity of each hand (what the child can do) during bimanual functions. PurposeThe aim of this study was to investigate the validity and reliability of the Turkish version of the BFMF-2.0 in children with CP. Study DesignClinical measurement and cross-sectional study. MethodsThe study included 91 children with CP (56 girls, mean age; 7.41 ± 4.23 years [4–18 years]) and their parents. The Manual Ability Classification System (MACS), the Quality of Upper Extremity Skills Test (QUEST), and the Box and Block Test (BBT) were used for construct and concurrent validity. Experienced/inexperienced therapists and parents classified fine motor capacities of the children via live or video-based observation to assess inter-rater reliability. Three weeks later, the children were reclassified for intra-rater reliability. ResultsThe Turkish version of the BFMF-2.0 classification was strongly correlated with the MACS (rho = −0.88, p < 0.001), the QUEST (rho = 0.80, p < 0.001), and the BBT (rho = −0.77, p < 0.001). The inter-rater reliability scores were weak to excellent between the parents and the therapists (via live observation, κw = 0.57) and also between experienced/inexperienced therapists (via live or video-based observation, κw = 0.66–0.79). Intra-rater reliability scores were good to excellent (Intraclass Correlation Coefficient [ICC] = 0.87–0.95). ConclusionsThe Turkish version of the BFMF-2.0 classification is valid and reliable and could be applied by experienced and inexperienced therapists via live or video-based observation and by parents via live observation.

Does bimanual task training benefit manual ability and hand function of children with bilateral spastic cerebral palsy?

Sixty percent of children with bilateral cerebral palsy have impaired hand function. The study's purpose was to examine the benefits of bimanual task practice on the manual ability and hand function of children with bilateral spastic cerebral palsy. In this pre-post study design, 18 children with bilateral spastic cerebral palsy with an average age of 11.5 (+/-1.9) years, Manual Ability Classification System levels I-III and Bimanual Fine Motor Function levels I-III participated in bimanual task practice of upper extremities. The task practice included clay activities, paper manipulation and activities of daily needs. The children underwent 45-minute training sessions 3 times a week over 6 weeks. The outcome measures were ABILHAND-Kids, Quality of Upper Extremity Skills Test and grip strength. Post-training, a mean change of 6.44 logits in ABILHAND-Kids, 11 points on the Quality of Upper Extremity Skills Test, and 3.3 and 3.1 kilograms grip strength in the dominant and nondominant hands respectively were observed with a statistical significance (p < 0.05). Bimanual task training might be beneficial in improving manual ability, hand function and grip strength in children with bilateral spastic cerebral palsy.

Is there a relationship between upper limb function and swallowing function in children with cerebral palsy? A cross-sectional study

Objective: Despite the association between gross motor and swallowing functions in patients with cerebral palsy (CP), there have been no studies examining the relationship between upper limb functions and swallowing in detail. The aim of this study was to evaluate the relationship between upper extremity skills and swallowing function in children with CP. Methods: The study included a total of 71 patients with CP who were attending the rehabilitation clinic. Upper limb functions were assessed using the Bimanual Fine Motor Function (BFMF) scale, and swallowing function with the Functional Oral Intake Scale (FOIS). The Nine-hole peg test (NPHT) was used to assess manual hand dexterity. Grip strength was measured with a Jamar hand dynamometer and pinchmeter. Correlation analysis was applied to outcome parameters. Results: The BFMF classification was level 1 in 6 patients (8.5%), level 2 in 22 patients (31.0%), level 3 in 27 patients (38.0%), level 4 in 12 patients (16.9%) and level 5 in 4 patients (5.6%). Nutrition was provided through oral intake in 59 (83.1%) patients and 12 (16.9%) were tube dependent. While a negative correlation was determined between swallowing function and BFMF and NHPT, a positive correlation was determined between swallowing function and grip strength values. Conclusions: The findings of this study demonstrated that there is a relationship between swallowing functions and upper limb functions. These findings may help in predicting functional improvement in terms of swallowing and/or if the patient needs further intervention such as upper limb rehabilitation in addition to oral motor training to improve oral intake, and thereby nutritional intake.

External validity of the Both Hands Assessment for evaluating bimanual performance in children with bilateral cerebral palsy.

To investigate the external validity of the Both Hands Assessment (BoHA), a new test evaluating bimanual performance in children with bilateral cerebral palsy (CP), by analysing its relationship to established measurements of hand function and self-care skills. In this cross-sectional study, we recruited children with bilateral CP and manual ability corresponding to Manual Ability Classification System (MACS) levels I to III attending three habilitation units in Norway. All participants completed the BoHA. Unimanual capacity was assessed using the Bimanual Fine Motor Function (BFMF) classification, the Boxand Block Test (BBT), and the Melbourne Assessment 2 (MA2). Self-care skills were assessed with the Pediatric Evaluation of Disability Inventory (PEDI). Thirty-nine children (19 males, 20 females; mean age 8y 2mo, SD 2y 8mo; age range 2y 8mo-12y 6mo) were included. Spearman's correlation coefficient (ρ) suggested high correlation between the BoHA and MACS (p=0.89; 95% confidence interval [CI] 0.79-0.94), BFMF classification (p=0.84; 95% CI 0.71-0.91), and BBT for the non-dominant (p=0.85; 95% CI 0.68-0.95) and dominant hand (p=0.72; 95% CI 0.53-0.85). The Spearman's ρ between the BoHA and the MA2 subscales varied between 0.48 and 0.83, while the PEDI's ρ was 0.51 (95% CI 0.33-0.67). The BoHA provides valid measures of hand use as suggested by its high correlation with other activity-based measures of hand function.

Assessment of Sleep-Related Problems in Children with Cerebral Palsy Using the SNAKE Sleep Questionnaire.

Cerebral palsy (CP) represents the most common motor impairment in childhood. The presence of sleep problems has not yet been investigated with an instrument specifically designed for this population. In this hospital-based, prospective study, N = 100 children (M = 7.9, range: 2–18 years) with CP were included. All patients underwent pediatric neurologists’ screening incorporating instruments (Data Collection Form; Gross Motor Functions Classification System, GMFCS; Bimanual Fine Motor Function, BFMF) recommended by the “Surveillance of Cerebral Palsy in Europe (SCPE)”. Parents completed the “Sleep Questionnaire for Children with Severe Psychomotor Impairment (SNAKE)”. Children’s sleep behavior was increasingly conspicuous, with greater gross motor (SNAKE scales: disturbances remaining asleep, daytime sleepiness) and fine motor (additionally SNAKE scale arousal and breathing problems) functional impairment. Overall, a proportion of children showed sleep behavior outside the SNAKE’s normal range. No relevant sleep differences were identified between different CP subtypes and comorbidities. Applying a population-specific questionnaire, children’s functional impairment seems to be more relevant to their sleep behavior than the CP subtype or CP comorbidities.

Neuroimaging Patterns and Function in Cerebral Palsy-Application of an MRI Classification.

Background: Cerebral palsy (CP) is a disorder of movement and posture and every child with CP has a unique composition of neurological symptoms, motor severity, and associated impairments, constituting the functional profile. Although not part of the CP definition, magnetic resonance imaging (MRI) sheds light on the localization, nature, and severity of brain compromise. The MRI classification system (MRICS), developed by the Surveillance of Cerebral Palsy in Europe (SCPE), describes typical MRI patterns associated with specific timing of vulnerability in different areas of the brain. The classification has proven to be reliable and easy to use.Aims: The aim of this study is to apply the MRICS on a large dataset and describe the functional profile associated with the different MRI patterns of the MRICS.Materials and Methods: Data on children with CP born in 1999–2009 with a post-neonatal MRI from 20 European registers in the JRC-SCPE Central Registry was included. The CP classification and the MRICS was applied, and The Gross Motor Function Classification (GMFCS) and the Bimanual Fine Motor Function (BFMF) classification were used. The following associated impairments were documented: intellectual impairment, active epilepsy, visual impairment, and hearing impairment. An impairment index was used to characterize severity of impairment load.Results: The study included 3,818 children with post-neonatal MRI. Distribution of CP type, motor, and associated impairments differed by neuroimaging patterns. Functional profiles associated with neuroimaging patterns were described, and the impairment index showed that bilateral findings were associated with a more severe outcome both regarding motor impairment and associated impairments than unilateral compromise. The results from this study, particularly the differences in functional severity regarding uni- and bilateral brain compromise, may support counseling and service planning of support of children with CP.

Visual Impairment and Functional Classification in Children with Cerebral Palsy.

Cerebral palsy (CP) is the most common motor impairment in childhood and often accompanied by a broad spectrum of comorbidities. Data are sparse concerning visual impairment (VI) and functional classification among CP children. The objective of this study was to analyze the prevalence of VI among children with CP and to investigate a possible association between VI and Gross Motor Function Classification System (GMFCS) and the Bimanual Fine Motor Function (BFMF). In this hospital-based study, records of 200 children with CP aged 2 to 17 years were reviewed. Overall, VI was found in 59.5% of children with CP. Prevalence of VI was higher when compared with non-CP children. A correlation between GMFCS as well as BFMF and severity of VI was found. Children with severe CP were at greater risk for severe VI, especially cerebral VI compared with children with mild CP. VI is a significant problem in children with CP and is correlated with motor function. Children with CP should undergo detailed ophthalmologic and orthoptic assessment to enable early intervention.

Motor functions, quality of life and maternal anxiety and depression in children with cerebral palsy of different intelligence levels.

Cerebral palsy (CP) is the most common motor disability in childhood. In addition to motor impairment, it is frequently accompanied by intellectual disability (ID). We aimed to investigate the associations between motor functions, quality of life (QoL) and maternal psychopathology in children with CP of different intelligence levels. In total, 37 children and adolescents (16 females and 21 males) between 4 and 18 years of age diagnosed with CP were recruited from a Pediatric Neurology Outpatient Clinic. Gross Motor Function Classification System (GMFCS) and Bimanual Fine Motor Function (BFMF) were used for the children`s motor functions assessment. Quality of life was determined by the caregivers with Pediatric Quality Of Life Inventory-Parent version (PedsQL-P). Maternal anxiety and depression levels were assessed using Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI). Moderate-severe ID (n=19)(13.5%, 37.8%) and normal IQ-mild ID (n=18) (32.4 %,16.2%) groups were evaluated in this study. GMFCS level 2 was more frequent in both groups. The majority of the severe-moderate ID group was at BFMF level 4, while the normal IQ-mild ID group was at BFMF level 2. PedsQL-P scores of children with CP, maternal BAI scores, and maternal BDI scores did not differ between the two groups (p > 0.05). Psychosocial PedsQL scores had a moderate negative correlation with the maternal BAI scores (r=- 0.41, p < 0.05). There was also a moderate positive correlations between the ages of children and maternal BDI scores (r=0.34, p < 0.05). Our results demonstrated that maternal anxiety was correlated with psychosocial QoL in children with CP. Maternal depression scores increasing with the ages of the children with CP may also indicate the social support needs for mothers with children of chronic diseases. Further studies may reveal the associations with other biopsychosocial factors in children with CP of different intelligence levels by using longitudinal study designs with larger sample sizes.

Effect of virtual reality therapy on functional development in children with cerebral palsy: A single-blind, prospective, randomized-controlled study.

The aim of this study was to investigate the effect of virtual reality (VR) therapy on motor and functional development in children with cerebral palsy (CP). In this single-blind, prospective, randomized-controlled study, a total of 41 patients (28 males, 13 females; mean age 8.49 years; range, 5 to 15 years) receiving inpatient treatment for CP were included between April 2009 and September 2009. The patients were randomly divided into two groups as the study group (n=21) and control group (n=20). Neurophysiological and conventional treatment methods, and occupational therapy were applied to all patients. In addition, a total of 12 VR therapy sessions for one hour were administered three days a week for four weeks to the study group. Before and after treatment, the Bimanual Fine Motor Function (BFMF) test was performed to measure hand functioning, Gross Motor Function Classification System (GMFCS) for functional levels, and Functional Mobility Scale (FMS) for mobility. There was a significant increase in the BFMF, GMFCS, and FMS scores after treatment, compared to baseline values in the study group (p<0.05). There was a statistically significant results in favor of the study group for all parameters after treatment compared to pre-treatment values (p<0.05). Our study results indicate that VR therapy is a useful treatment method which can be used in rehabilitation of CP with improved motor function. The addition of this method to conventional rehabilitation techniques may have a significant impact on treatment success.

Visual impairment in children with cerebral palsy: Croatian population-based study for birth years 2003-2008

AimTo evaluate visual impairment (VI) in children with cerebral palsy (CP).MethodsThis population-based study included 419 children from the Surveillance of Cerebral Palsy in Europe (SCPE) C28 RCP-HR – Register of Cerebral Palsy of Croatia born 2003-2008. Vision in children with CP (according to SCPE) was classified as normal or impaired, with the subcategory of severe VI. The proportion of children with VI was assessed in groups with different CP type/subtype, gross and fine motor function, and gestational age (GA).ResultsA total of 266 children had some degree of VI (266/400; 66.5%), 134 had normal vision, and data on VI were unknown for 19 children. Severe VI was present in 44 children (44/400; 11%). The proportion of children with VI and severe VI increased with the Gross Motor Function Classification System and Bimanual Fine Motor Function levels. Children with bilateral spastic CP had the highest frequency of severe VI (14.9%). The percentage of severe VI in children with bilateral spastic CP was 53.8% in the group born <28 weeks of GA, 13.3% in the group born 28-31 weeks of GA, 11.1% in the group born 32-36 weeks of GA, and 24.4% in the group born >36 weeks of GA (λ2 = 4.95; df = 6; P < 0.001).ConclusionChildren with CP have a high prevalence of VI and severe VI, which is increasing with the level of motor impairment. Severe VI is significantly more common in children with bilateral spastic CP, especially among extremely premature infants.

Profile of motor abilities of children with cerebral palsy as a predictor of their functional independence in self-care and mobility

Introduction/Objective. Limitations of mobility and motor deficits are identified as predominant in the clinical picture of cerebral palsy. This research aimed to describe the profile of motor abilities of children with cerebral palsy, which included gross motor, manual, and bimanual fine motor functions, and to determine the extent to which their functional independence in self-care and mobility was influenced by the profile of their motor abilities. Methods. A convenience sample of 117 participants with cerebral palsy (56.4% males), aged 7?18 years (M = 13.2, SD = 3.4), was included. The Gross Motor Function Classification System ? Expanded and Revised, Manual Ability Classification System, Bimanual Fine Motor Function and the Functional Independence Measure ? Version for Children, were used. Data was analyzed by descriptive statistics and hierarchical multiple regression. Results. More than a half of sample exhibited different levels of gross motor, manual, and bimanual function. Lower functional independence in self-care and mobility was associated with higher functional limitations. Manual abilities were the strongest predictor of functional independence in self-care (? = -0.63, p &lt; 0.001), while gross motor functions were the strongest predictor in the mobility domain (? = -0.65, p &lt; 0.001). Conclusion. Improvement of gross motor and manual abilities of children with cerebral palsy is confirmed as one of the basic preconditions for achieving a greater independence and for minimizing or eliminating a need for assistance in mobility and in everyday self-care activities.

Community-Based Upper Extremity Power Training for Youth with Cerebral Palsy: A Pilot Study

Aim: To examine the effects of an upper-extremity, community-based, and power-training intervention.Methods: Twelve participants with cerebral palsy (CP) [8 males, 4 females; mean age 14 years 6 months (SD 5 years 4 months), range 7–24] were randomly assigned to a rest-training (RT; n = 6) or training-rest (n = 6) group in this randomized, cross-over design. Training took place in participants’ home or school, three times per week for 6 weeks. We examined changes in upper extremity average power output (Pavg) in watts (W) and changes in function via the Pediatric Outcomes Data Collection Instrument (PODCI).Results: Each participant completed at least 15 of the 18 total training sessions (91.2% adherence). Pavg increased 92.2% on average among participants (p < .05). There was a significant three-way interaction among treatment, sequence, and period with the data stratified by (Bimanual Fine Motor Function [BFMF]) level on the pain subscale of the PODCI (p = 0.0118). All participants decreased pain after training with the exception of individuals with lower functioning (BFMF II-V) in the RT group.Conclusion: A community-based upper extremity power-training intervention was feasible and effective at improving power among young people with CP and has the potential to improve pain.

Intelligence, Functioning, and Related Factors in Children with Cerebral Palsy.

Cerebral palsy (CP) is the most common significant motor impairment in childhood. CP is defined as a primary disorder of posture and movement; however, intellectual impairment is prevalent in children with CP. The purpose of this study was to examine the intelligence level associated with gross motor function and hand function, type of CP, the presence of comorbid disorders such as epilepsy, and other factors. In total, 107 children with CP were included. Age, gender, prenatal/natal/postnatal risk factors, type of CP, and presence of other neurodevelopmental disorders were recorded as demographic findings. Intellectual functions of the patients were determined by clinical assessment, adaptive function of daily life, and individualized, standardized intelligence testing. The gross motor function and hand function of the patients were classified using the "Gross Motor Function Classification System" and "Bimanual Fine Motor Function" measurements, respectively. The mean age of the patients was 8.10±3.43 years (2-16 years). The study included 63 (58.9%) male patients and 44 (41.1%) female patients. During clinical typing, 80.4% of the patients were spastic, 11.2% were mixed, 4.7% were dyskinetic, and 3.7% were ataxic. Intellectual functioning tests found 26.2% of the children within the intellectual norm and that 10% of the children had a borderline intellectual disability, 16% of them had a mild intellectual disability, 17% of them had a moderate intellectual disability, and 30.8% of them had a severe intellectual disability. No significant relationship was determined between the CP type and intellectual functioning (p>0.05). Intellectual functioning was found to be significantly correlated with hand functions and motor levels (p<0.001). Factors related with intellectual functioning were neonatal convulsion, epilepsy, and speech disorders. Intelligence assessment should be an essential part of CP evaluation and research. There is not enough reliable knowledge, unanimity regarding validity data, and population-specific norms in the intelligence assessments of children with CP. Research is required to assess properly intelligence for children with CP.

Intelligence functioning and associated factors in children with cerebral palsy

ObjectivesCerebral palsy (CP) is described as a primary disorder of posture and movement; however, intellectual impairment is prevalent in children with CP.AimThe aim of the present study was to examine the association with intellectual level and gross motor function, hand function, type of CP, and the presence of co-morbid disorders in these children.MethodsA total of 107 children with CP were included in the study. Intellectual functions of the children were determined by clinical assessment, adaptive function of daily life, and individualized standardized intelligence testing. Gross motor function and hand function of the patients were classified using the gross motor function classification system and the bimanual fine motor function measurements.ResultsThe mean age of the patients were 8.10 ± 3.43 years (age: 2–16 years). During clinical typing, we observed that 80.4% of the patients were spastic, 11.2% were mixed, 4.7% were dyskinetic, and 3.7% were ataxic. No significant relationship was determined between the type of CP and intellectual functioning (P &gt; 0.05). Intellectual functioning was found to be significantly correlated negatively with both gross motor function and hand functions level (P &lt; 0.001). The factors related to intellectual functioning were neonatal convulsion (x2 = 12.97, P = 0.002), epilepsy (x2 = 29.221, P &lt; 0.001), and speech disorders (x2 = 23.29, P &lt; 0.001).ConclusionsThere is an association between intellectual functioning in children with CP and the degree of motor impairment, neonatal convulsion, epilepsy, and speech disorders. Intelligence assessment should be an essential part of CP evaluation.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Bimanual Capacity of Children With Cerebral Palsy: Intra- and Interrater Reliability of a Revised Edition of the Bimanual Fine Motor Function Classification

ABSTRACTAims: To develop a revised edition of the Bimanual Fine Motor Function (BFMF 2), as a classification of fine motor capacity in children with cerebral palsy (CP), and establish intra- and interrater reliability of this edition. Methods: The content of the original BFMF was discussed by an expert panel, resulting in a revised edition comprising the original description of the classification levels, but in addition including figures with specific explanatory text. Four professionals classified fine motor function of 79 children (3–17 years; 45 boys) who represented all subtypes of CP and Manual Ability Classification levels (I-V). Intra- and inter-rater reliability was assessed using overall intra-class correlation coefficient (ICC), and Cohen's quadratic weighted kappa. Results: The overall ICC was 0.86. Cohen's weighted kappa indicated high intra-rater (кw: >0.90) and inter-rater (кw: >0.85) reliability. Conclusions: The revised BFMF 2 had high intra- and interrater reliability. The classification levels could be determined from short video recordings (<5 minutes), using the figures and precise descriptions of the fine motor function levels included in the BFMF 2. Thus, the BFMF 2 may be a feasible and useful classification of fine motor capacity both in research and in clinical practice.

Predictors of participation change in various areas for preschool children with cerebral palsy: a longitudinal study.

This study identifies potential predictors of participation changes in various areas for preschool children with cerebral palsy (CP). Eighty children with CP (2-6 years) were enrolled. Seven potential predictors were identified: age; sex; socioeconomic status, CP subtype; cognitive function, Function Independence Measure for Children (WeeFIM), and motor composite variable from 5 motor factors (gross motor function classification system (GMFCS) level; bimanual fine motor function level; selective motor control score; Modified Ashworth Scale score; and Spinal Alignment and Range of Motion Measure). Outcome was assessed at baseline and at 6-month follow-up using the Assessment of Preschool Children's Participation (APCP) including diversity and intensity scores in the areas of play (PA), skill development (SD), active physical recreation, social activities (SA), and total areas. Dependent variables were change scores of APCP scores at baseline and 6-month follow-up. Regression analyses shows age and sex together predicted for APCP-total, APCP-SD diversity and APCP-total intensity changes (r(2)=0.13-0.25, p<0.001); cognitive function and WeeFIM were negative predictors for APCP-SA and APCP-PA diversity changes, respectively. CP subtype, motor composite variable, and socioeconomic status predicted for APCP changes in some areas. Findings suggest that young boys with poor cognitive function and daily activity predicted most on participation changes.

Bimanual Fine Motor Function (BFMF) Classification in Children with Cerebral Palsy: Aspects of Construct and Content Validity

ABSTRACTThe Bimanual Fine Motor Function (BFMF) is currently the principal classification of hand function recorded by the Surveillance of Cerebral Palsy in Europe (SCPE) register. The BFMF is used in a number of epidemiological studies, but has not yet been validated. Aims: To examine aspects of construct and content validity of the BFMF. Methods and Results: Construct validity of the BFMF was assessed by comparison with the Manual Ability Classification System (MACS) using register-based data from 539 children born 1999–2003 (304 boys; 4–12 years). The high correlation with the MACS (Spearman's rho = 0.89, CI: 0.86–0.91, p<.001) supports construct validity of the BFMF. The content of the BFMF was appraised through literature review, and by using the ICF-CY as a framework to compare the BFMF and MACS. The items hold, grasp and manipulate were found to be relevant to describe increasingly advanced fine motor abilities in children with CP, but the description of the BFMF does not state whether it is a classification of fine motor capacity or performance. Conclusion: Our results suggest that the BFMF may provide complementary information to the MACS regarding fine motor function and actual use of the hands, particularly if used as a classification of fine motor capacity.

PS-247 Association Of Motor Function With Basal Ganglia And Thalamus Volumes In Dyskinetic Cerebral Palsy

<h3>Background and aims</h3> Dyskinetic Cerebral Palsy (CP) is mainly characterised by basal ganglia and thalamus injury as well as worse motor functioning compared to other CP types. Associations of higher levels in Gross Motor Function Classification System (GMFCS) and in Bimanual Fine Motor Function (BFMF) with basal ganglia and thalamus lesions have only been described qualitatively. This study aims to analyse the quantitative relationship of basal ganglia and thalamus volumes with motor status measured by means of the three Surveillance of Cerebral Palsy in Europe (SCPE) recommended scales: GMFCS, BFMF and Manual Ability Classification System (MACS). <h3>Methods</h3> Gross and fine motor status of 15 dyskinetic CP participants with signs of perinatal asphyxia (age range: 12–34) were assessed. 3T-MRI was obtained and Free Surfer software was used to estimate basal ganglia and thalamus volumes. Partial correlations controlling for age were performed. <h3>Results</h3> Caudate (r = -.70; p &lt; 0.01), putamen (r = -.59; p &lt; 0.05) and pallidum (r = -.60; p &lt; 0.05) volumes correlated with GMFCS. Moreover, caudate (r = -.68; p &lt; 0.01), putamen (r = -.63; p &lt; 0.05) and thalamus (r = -.55; p &lt; 0.05) volumes correlated with MACS. BFMF was not related with basal ganglia and thalamus measures. <h3>Conclusions</h3> Greater gross and fine motor impairment severity is associated with lower basal ganglia and thalamus volumes, which is consistent with qualitative results of previous studies. This is the first evidence of a quantitative relationship between two widely used scales of motor functioning and deep brain grey matter in dyskinetic CP. GMFCS and MACS, but maybe not BFMF scale, are sensitive to basal ganglia and thalamus injury in this CP type.