Manual Ability Classification System Research Articles

Clinical characteristics and rehabilitation potential in children with cerebral palsy based on MRI classification system.

The correlation of clinical characteristics of cerebral palsy (CP) and the magnetic resonance imaging classification system (MRICS) for (CP) is inconsistent. Specifically, the variance in rehabilitation potential across MRICS remains underexplored. To investigate the clinical characteristics and potential for rehabilitation in children with CP based on MRICS. Children with CP admitted to the Department of Rehabilitation, Children's Hospital of Chongqing Medical University between 2017 and 2021 were included in the study. Qualified cases underwent a follow-up period of at least one year. The clinical characteristics of CP among different MRICS were analyzed, then the rehabilitation potential was explored by a retrospective cohort study. Among the 384 initially enrolled children, the male-to-female ratio was 2.3:1, and the median age of diagnosis was 6.5 months (interquartile range: 4-12). The most prevalent MRICS categorization was predominant white matter injury (40.6%), followed by miscellaneous (29.2%) and predominant gray matter injury (15.6%). For the predominant white matter injury and miscellaneous categories, spastic diplegia emerged as the leading subtype of CP, with incidences of 59.6% and 36.6%, respectively, while mixed CP (36.7%) was the most common type in children with predominant gray matter. Notably, 76.4% of children with predominant white matter injury were classified as levels I-III on the gross motor function classification system (GMFCS), indicating significantly less severity than other groups (χ2 = 12.438, p = 0.013). No significant difference across MRICS categories was observed for the manual ability classification system (MACS) (H = 8.176, p = 0.085). Rehabilitation potential regarding fine motor function and adaptability based on Gesell assessment was dependent on MRICS over the follow-up period. Children with normal MRI scans exhibited superior rehabilitation outcomes. Commencing rehabilitation at an earlier stage produced consistent and beneficial results in terms of fine motor function and adaptability across all MRICS categories. Moreover, participants below 2 years of age demonstrated enhanced rehabilitation potential regarding fine motor outcomes and adaptability within the MRICS framework. MRICS displayed a significant association with clinical characteristics and rehabilitation efficacy in children with CP.

Identifying the most representative actigraphy variables reflecting standardized hand function assessments for remote monitoring in children with unilateral cerebral palsy

BackgroundAccurate assessment of physical activity and motor function in children with cerebral palsy is crucial for determining the effectiveness of interventions. This study aimed to investigate the correlation between real-world activity monitoring outcomes and in-laboratory standardized hand function assessments in children with unilateral cerebral palsy.MethodsActigraphy data were collected over 3 days from children aged 4–12 years with unilateral cerebral palsy before in-laboratory assessments. To tackle the high dimensionality and collinearity of actigraphy variables, we first applied hierarchical clustering using the Pearson correlation coefficient as the distance metric and then performed a principal component analysis (PCA) to reduce the dimensionality of our data.ResultsBoth hierarchical clustering and PCAs revealed a consistent pattern in which magnitude ratio variables (ln[affected side magnitude/less-affected side magnitude]) were more strongly associated with standardized assessments of hand function than with activity time and distance domain variables. Hierarchical clustering analysis identified two distinct clusters of actigraphy variables, with the second cluster primarily consisting of magnitude ratio variables that exhibited the strongest correlation with Melbourne Assessment 2, Pediatric Motor Activity Log, Assisting Hand Assessment, and Manual Ability Classification System level. Principal component 2, primarily representing the magnitude ratio domain, was positively associated with a meaningful portion of subcategories of standardized measures, whereas principal component 1, representing the activity time and distance component, showed limited associations.ConclusionsThe magnitude ratio of actigraphy can provide additional objective information that complements in-laboratory hand function assessment outcomes in future studies of children with unilateral cerebral palsy.Trial registration in ClinicalTrials.govNCT04904796 (registered prospectively; date of registration: 23/05/2021).

Estimating the Prevalence of Cerebral Palsy in a Semi-Urban City in Benin: A Door-to-Door Community-Based Study

Introduction: Cerebral palsy (CP) is the most common cause of pediatric motor disability. While epidemiological data are widespread in high-income countries, corresponding data in low-income countries in sub-Saharan Africa are still rare. This study aimed to estimate the prevalence of CP in Northern Benin, a French-speaking low-income country in sub-Saharan Africa. Methods: This study was a community-based door-to-door study involving children younger than 18 years old, in Parakou, a semi-urban city in Benin. We used a two-stage procedure. The first one consisted on children screening to identify potential cases of CP. During the second stage, suspected children were examined by neurologists with high experience with CP. Results: In total, 2,630 children were screened with 10 confirmed cases of CP, resulting in a crude prevalence (95% confidence interval) of 3.8 (1.4, 6.15) per 1,000 children. Of the 10 confirmed cases, six were younger than 5 years old, and five were male. Eight children over ten were spastic with six bilateral spastic subtype according to the Surveillance of Cerebral Palsy in Europe classification system. Seven children had a Gross Motor Function Classification System level III–V, and six were classified level III to V of the manual ability classification system. Conclusion: CP is highly prevalent in semi-urban area in Northern Benin. Large studies on potential risk factors are needed for the development of effective preventive strategies.

The effect of proprioceptive neuromuscular facilitation on functional skills, muscle strength, and trunk control in children with cerebral palsy: A randomized controlled trial

BackgroundProprioceptive neuromuscular facilitation (PNF) is generally used for the lower limbs in children with Cerebral Palsy (CP). This study aimed to determine the effect of PNF and Neurodevelopmental Therapy (NDT) on functional abilities, muscle strength, and trunk control in children with CP. MethodsThirty spastic CP children classified as either level I–II in the Gross Motor Function Classification System (GMFCS) or level I–II in the Manual Ability Classification System (MACS) were included. The PNF (n = 15) and the NDT group (n = 15) had physiotherapy for six weeks. The ABILHAND-Kids scale, the Purdue Pegboard Test (PBPT), the Nine-Hole Peg Test (9-HPT), and the Jebson-Taylor Hand Function Test (JTHFT) were employed. Pinch meters, Jamar handheld dynamometers, and digital muscular strength assessments were used. ResultsThe PNF group increased shoulder flexion (p < 0.05), adduction (p < 0.05), elevation (p < 0.05), scapular abduction (p < 0.05), elbow extension (right) (p < 0.05), grip (p < 0.05), and pinch strengths (left p < 0.05, right p < 0.05). The PNF group had significantly lower 9-HPT (p < 0.05), JTHFT (card turning), JTHFT (simulated feeding), JTHFT (lifting light cans), and JTHFT (lifting weight cans) durations (p < 0.05), and significantly higher PBPT (right-left) PBPT (bimanual), PBPT (assembly).(p < 0.05), ABILHAND (p < 0.05), and TCMS total scores (p < 0.001). While JTHFT (simulated feeding-left), JTHFT (stacking checkers-left), JTHFT (lifting light cans-left), and JTHFT (lifting weight cans-right/left) (p < 0.05) durations decreased in the NDT group, PBPT (right) (p < 0.05) had an increase in duration. ConclusionPNF improves trunk control, upper extremity functional skills, selective proximal muscle strength, and distal upper extremity muscle and grip strength.

Cross-cultural adaptation, validity and reliability of the Japanese version of ABILHAND-kids for children with cerebral palsy using Rasch measurement model

Purpose The aim of this study was to develop the Japanese version of the ABILHAND-Kids and to examine its psychometric properties for Japanese children with cerebral palsy (CP). Methods The experimental version of 75 items was developed using forward-backward translation method. Parents of 137 children with CP answered it. Their responses were analyzed to successive items, and psychometric properties of the final version were investigated through the Rasch measurement model. Results The Japanese version of the ABILHAND-Kids contained 22 items. It showed valid item-patient targeting, no significant floor and ceiling effects, and no differential item functioning for demographic and clinical subgroups. All items contributed to the definition of one-dimensional measure. For internal consistency, the person separation index was 0.94. For test-retest reliability, the intraclass correlation coefficients were 0.96 (95% CI: 0.92–0.98). The minimal detectable difference was calculated with a logit score of 0.79 and a total raw score of 4.50. The logit score showed a strong correlation with the Manual Ability Classification System level (ρ= −0.70) and the Gross Motor Function Classification System level (ρ= −0.62). Conclusions The Japanese version of the ABILHAND-Kids was found to be valid and reliable. It appears to be a good tool for assessing manual abilities in daily activities in children with CP.

Neuroanatomical correlates of gross manual dexterity in children with unilateral spastic cerebral palsy.

Unilateral spastic Cerebral Palsy (UCP) results from congenital brain injury, and Magnetic Resonance Imaging (MRI) has a role in understanding the etiology and severity of brain insult. In UCP, functional impairment predominantly occurs in the upper limb (UL) of the more affected side, where manual ability and dexterity are typically reduced. Also, mirror movements (MMs), are often present in UCP, with a further possible negative functional impact. This study aims to investigate the relationships among neuroanatomical characteristics of brain injury at MRI, manual functional impairment and MMs, in children with UCP. Thirty-five children with UCP participated in the study (20, M = 15, F, mean age 9.2 ± 3.5 years). Brain lesions at MRI were categorized according to the Magnetic Resonance Classification System (MRICS) and by using a semi-quantitative MRI (sqMRI) scale. Gross manual performance was assessed through Manual Ability Classification System (MACS) and the Box and Block Test (BBT), and MMs by Woods and Teuber scale, for both hands. Non-parametric correlation analyses were run to determine the relationship between neuroanatomical and functional features. Regression models were run to explore the contribution of neuroanatomical features and MMs to UL function. Correlation analyses revealed moderate to strong associations between sqMRI scores contralateral to the more affected side and UL functional impairment on MACS and BBT, with more severe brain injuries significantly correlating with poorer function in the more affected hand. No association emerged between brain lesion severity scores and MMs. MRICS showed no association with MACS or BBT, while a significant correlation emerged between MRICS category and MMs in the more affected hand, with brain lesion category that are suggestive of presumed earlier injury being associated with more severe MMs. Finally, exploratory regression analyses showed that neuroanatomical characteristics of brain injury and MMs contributed to the variability of UL functional impairment. This study contributes to the understanding of the neuroanatomical and neurological correlates of some aspects of manual functional impairment in UCP by using a simple clinical brain MRI assessment.

Validity and reliability of the Sitting Assessment Scale in cerebral palsy.

The aim of this study was to examine the validity and reliability of the Sitting Assessment Scale (SAS) in individuals with cerebral palsy (CP). The study included 34 individuals with a diagnosis of spastic CP. Individuals were evaluated with the Gross Motor Function Classification System and the Manual Ability Classification System. SAS and Trunk Control Measurement Scale (TCMS) were applied to the participants. The intraclass correlation coefficient (ICC) was calculated to determine the intraobserver and interobserver reliability of the scale scored by three different physiotherapists at two different time intervals. Internal consistency was calculated with Cronbach's ⍺ coefficient. The fit between SAS and TCMS for criterion-dependent validity was evaluated using Pearson Correlation Analysis. According to the GMFCS level, 79.41% of the children were mildly (Level I-II), 14.71% were moderately affected (level III), and 5.88% were severely affected (level IV). Intra > observer and interobserver reliability values of SAS were extremely high (ICCinterrater > 0.923, ICCintrarater > 0.930). It was observed that the internal consistency of SAS had high values (Cronbach ⍺test > 0.822, Cronbach ⍺retest > 0.804). For the criterion-dependent reliability; positive medium correlations found between SAS with Total TCMS Static Sitting Balance (r = 0.579, p < 0.001), with TCMS Selective Movement Control (r = 0.597, p < 0.001), with TCMS Dynamic Reaching (r = 0.609, p < 0.001), and with TCMS Total (r = 0.619, p < 0.001). SAS was found to have high validity and reliability in children with CP. In addition, the test-retest reliability of the scale was also high. SAS is a practical tool that can be used to assess sitting balance in children with CP.

Participation in physical activity by adolescents with physical disability: Protocol for a national participation snapshot and Delphi consensus study (“Youth Experience Matters”)

Young people with physical disability experience challenges to being physically active. To attain the health benefits of physical activity (PA) and sustain engagement, it is essential that participation is meaningful and enjoyable. This study aims to describe current participation in PA by adolescents with physical disability in Ireland, and to establish consensus on their priorities for enhancing physical activity participation. A parallel convergent mixed methods study will be undertaken, comprising a national cross-sectional quantitative assessment of PA participation (“Participation Snapshot”) and Delphi consensus study (“Delphi”). Adolescents (n=100) aged 13–17 years with a physical disability will be invited to take part. The Participation Snapshot primary outcome is the Children’s Assessment of Participation and Enjoyment (CAPE). Contextual factors including underlying medical diagnosis, demographics, mobility (Functional Mobility Scale), hand function (Manual Ability Classification System) and health related quality of life (Child Health Utility 9D) will also be collected. The Delphi will comprise two to four survey rounds, until consensus is reached. Round 1 consists of a bespoke survey, designed and piloted with a public and patient involvement (PPI) panel, with open-ended questions and Likert scales inviting contributions from adolescents on their prior experience and ideas to enhance participation. Responses will be analysed using inductive thematic analysis to construct items and themes, which will then be deductively mapped to the “F-words” and the family of Participation-Related Constructs frameworks. These items will be presented back to participants in subsequent rounds for selection and ranking, until consensus is achieved on the “top 10 priorities” for enhancing PA participation. The project team and PPI panel will then co-design dissemination material and identify targets for dissemination to relevant stakeholder or policy groups. The findings will provide a basis for developing interventions aiming to enhance future PA participation for adolescents with physical disability.

Sensory processing abilities in relation to motor capabilities in children with different types of cerebral palsy

Background and purpose. children with cerebral palsy have sensory processing issues as well as motor problems, which lead to severe developmental disability. In this study, we aimed to assess correlation between sensory processing abilities and motor capabilities in children with cerebral palsy and assess the effect of cerebral palsy types on sensory processing abilities and motor capabilities. Materials and methods. One hundred cerebral palsy children of both sex were included in the study; their age ranged from 4-10 years old were selected from pediatric rehabilitation out clinic of faculty of Physical Therapy Cairo University, fulfilling inclusion criteria. All children were assessed by Short sensory profile: to measure sensory processing ability, Gross Motor Function Classification System: to measure the gross motor skills and Manual Ability Classification System: to measure the fine motor skills. Result. there was a significant correlation between GMFCS, MACS and the total score of SSP as well as Low energy weak, tactile sensitivity score, taste smell sensitivity, Movement sensitivity, and Under-responsive seeks sensation (P ≤ 0.05*). There was no significant correlations between both auditory filtering and Visual-auditory sensitivity with GMFCS and MACS (P = 0.676 and 0.266, respectively). There was statistical variation among different CP types regarding SSP and motor assessment (P ≤ 0.05*). Conclusion. the study showed: sensory processing abilities effect on motor capabilities in children with cerebral palsy.

The Impact of Pain in Individuals with Cerebral Palsy on Parents

Aim: The aim of this study is to evaluate the pain seen in individuals with Cerebral Palsy (CP) and to investigate its impacts on the parents. Material and Methods: The study included 66 individuals with Cerebral Palsy aged between 6-16, with a mean age of 8.83±3.17. The levels of the individuals included in the study were determined using the Gross Motor Function Classification System and the Manual Ability Classification System. The pain intensity of the individuals with Cerebral Palsy was assessed through a visual analog scale reported by the parents. The Impact on Family Scale was used to determine the state of the parents' impact. Results: A significant positive correlation was found between the visual analog scale and sub-parameters of the Impact on Family Scale, excluding the coping parameter (p

Effects of a Game Therapy program with Leap Motion Sensor on the Manual Function in Adults with Cerebral Palsy

Hand motor rehabilitation programs require long-term therapy and they are generally uninteresting and repetitive for the patient who is not always motivated to achieve them. The literature shows that Virtual Reality (VR) can increase motivation and engagement in motor rehabilitation programs. The aim of this study was to evaluate the effects of game therapy program for adults with cerebral palsy. The study included five adults with CP, levels 3 and 4 from Manual Ability Classification System (MACS). The manual function was evaluated before and after the game programs by the Box and Blocks and Jebsen-Taylor tests. The program was offered in 15 sessions, twice a week, in a care association for people with CP. The results indicated the stability of the condition, which can be expected for the adult population. Some games were more motivating and through testimonials, participants demonstrated satisfaction and suggested technical changes for better usability of the games. Motivators therapeutic resources should be considered in adult therapy with CP.

The Effect of Robotic Rehabilitation on Hand Functions and Quality of Life in Children with Cerebral Palsy: A Prospective Randomized Controlled Study.

This study aimed to examine the impact of robotic hand rehabilitation on hand function and quality of life in children with cerebral palsy. Children with cerebral palsy aged 7-16 years were divided into robotic rehabilitation (n = 9) or conventional rehabilitation (n = 10) groups for hand rehabilitation of 30 sessions. The primary outcomes were the Fugl-Meyer Assessment for Upper Extremity, and Box and Block Test. The secondary outcomes were the Manual Ability Classification System, Modified Ashworth Scale, hand grasp and finger strengths, ABILHAND-Kids, Functional Independence Measure for Children, and PedsQL Quality of Life Inventory-CP Module. In the robotic rehabilitation group, a significant improvement was found in all parameters after treatment (p < 0.05), except for the Functional Independence Measure (p = 0.081). In the conventional rehabilitation group, there was significant improvement after treatment in the Modified Ashworth Scale, Fugl-Meyer Assessment for Upper Extremity, hand grasp strength, Box and Block Test, ABILHAND-Kids, and PedsQL Quality of Life Inventory-CP Module (p < 0.05). Before and after treatment, all outcome parameters in the groups were similar (p > 0.05). Robotic hand rehabilitation is effective in improving motor function, manual dexterity, spasticity and quality of life in children with cerebral palsy. However, it was not demonstrated to be superior to conventional rehabilitation.

Aspects of Physical Activity and Quality of Life in Adults with Cerebral Palsy

ABSTRACT Background: Physical activity and sedentary behavior may differentially impact health-related quality of life in adults with cerebral palsy. Objective: The present investigation assessed the independent relationships between aspects of physical activity and sedentary behavior related to health related quality of life in adults with cerebral palsy. Methods: Through a cross-sectional online survey of 118 adults with cerebral palsy, participants self-reported the extent of their functional impairments using the Gross Motor Function Classification System, Manual Ability Classification System, and Communication Function Classification System; while mental and physical health-related quality of life were assessed using the RAND-36. Physical activity and sedentary behavior were quantified using the Physical Activity and Disability Survey—Revised and Sedentary Behavior Questionnaire, respectively. Results: Accounting for potential confounding influences of impairments, neither exercise-related physical activity, leisure time- related physical activity, occupational physical activity, nor sedentary behavior was associated with any characterization of health-related quality of life. However, greater engagement in general lifestyle physical activity was related to superior mental health-related quality of life. Conclusion: These findings provide initial evidence to suggest that focusing public health and therapeutic recommendations for individuals with cerebral palsy on general physical activity engagement throughout the day might incur potential benefits for enhancing mental health- related quality of life in this population.

Investigating the Predictive Factors of Life Balance in Mothers of Children with Cerebral Palsy

Introduction: Having a child with cerebral palsy (CP) is a stressful experience for the family, particularly mothers. Caring for these children occupies great time and energy from the family. The balance of life may be decreased by the influence of factors related to the child or mother. Accordingly, this study investigates the predictive factors affecting the life balance of mothers with CP&#x0D; Materials and Methods: This cross-sectional descriptive-analytical research was conducted in Ahvaz City, Iran, in 2021. A total of 135 mothers (mean age=33.37 [7.93]) with at least one child under the age of ten suffering from CP participated in this research. The data were collected using the life-balance index, general health questionnaire, time management quality, and demographic information checklists. The gross motor function classification system was expanded and revised, and the manual ability classification system was used to determine the gross motor and manual ability function levels. Generalized univariate linear models were used to investigate the effects of predictor variables on the quantity of life balance.&#x0D; Results: The life balance of mothers of children with CP was heavily unbalanced (45.2%) or unbalanced (35.6%). Based on the regression coefficient of each variable, it was determined that manual ability classification system (β=0.192), comorbidity in the children with CP (β=0.187), gross motor function (β=0.137), general health (β=0.024), and maternal age (β=0.01), respectively, contributed the most in the prediction of life balance variances.&#x0D; Conclusion: Life balance is a seriously affected domain in mothers caring for CP children. Child-related factors had a more effective role in predicting the life balance of mothers of CP children than mother-related factors

Characterization of environmental factors in children and adolescents with cerebral palsy in Minas Gerais: Participa Minas.

To characterize the environmental factors of children and adolescents with Cerebral Palsy (CP) in the state of Minas Gerais (MG), Brazil. This is a cross-sectional study involving 164 caregivers of children/adolescents with CP, aged 1-14 years. The Gross Motor Function Classification System (GMFCS) and the Manual Ability Classification System (MACS) were used to classify the participants' functioning, and environmental factors were evaluated by an on-line questionnaire that examined products and technologies, physical environment, services, and systems. A descriptive analysis was performed using percentage and frequency. Most participants had bilateral CP (66.9%) and 45% of them were spastic. Levels II and V of the GMFCS and MACS were the most frequent. About half (49.4%) used anticonvulsants, 27.4% underwent botulinum toxin application, and 29% went through orthopedic surgery in the lower limbs. Among the participants, 71.3% used orthoses in the lower limbs, and 51.8% used the public health care system. Most had access to physiotherapy (91.5%), but found difficulties to access interventions with other professionals, such as psychologists (28%) and nutritionists (37.8%). The school was the most frequently adapted environment (78%), and had the highest level of structural adaptation (42.7%). The results of this study suggest that the barriers to access health services and barriers to the physical environment may impact participation and social inclusion.

Associação entre desempenho funcional de crianças com paralisia cerebral e tempo de espera pela provisão de órteses em serviço de reabilitação

Children with cerebral palsy usually need orthoses in their thumbs for manual functions. Objective: Analyzing the association between the waiting time for receiving a thumb orthosis, the manual ability, and the difficulty in performing daily tasks of children with cerebral palsy. Method: Mixed-methods study, with a retrospective cohort and cross-sectional evaluation of children with cerebral palsy and the indication and confection of thumb orthoses. Data collection included socioeconomic information, waiting time for the orthoses, and assessments of the difficulty to carry out daily activities and of manual functioning according to the Manual Ability Classification System (MACS). Descriptive analysis, Spearman’s coefficient and the Kruskal-Wallis test were calculated in the IBM software SPSS®. Results: 17 children and their parents/guardians were evaluated. Most were male (76.5%) with hemiplegic cerebral palsy (52.9%). Their mean time waiting for the orthosis was 34.12 days (SD= 39.01). Children with a more severe motor impairment (p= 0.038) or worse manual abilities (p= 0.012) waited to receive the orthosis for a shorter period. There was no statistical difference between the waiting time for the orthosis and the difficulty to perform daily tasks. Conclusion: The correlation between manual ability and the waiting time reiterates the importance of functional evaluations to prioritize the concession of Assistive Technology devices in public rehabilitation services, focusing the care on the more specific needs of each child.

Tendon transfer in spastic cerebral palsy upper limb.

Cerebral palsy (CP) in upper limb produces functional, aesthetic and hygienic issues, and is not always amenable to surgical procedures. We are reporting a single-center, long follow-up experience with tendon transfer in wrist and forearm CP. The CP cases who had undergone tendon transfer in hand, wrist and forearm in a 14-year period were evaluated for change in motion, function and cosmetic appearance and also assessed by Manual Ability Classification System (MACS), and Dash (Disability of Arm, Shoulder, Hand) scores. Forty-two spastic CP patients with a mean age of 19.81 (10-34 years, SD: 5.36) years with a mean follow-up of 5.5 (2-14) years, entered the study. 24 cases were GMFCS I or II and 18 were III or IV. Supination beyond neutral was seen in 48.5%, and improvement in MACS scores in all the cases. Improved 'grasp' and 'release' and keyboard use was seen in 50%, 71% and 87% respectively. The satisfaction from appearance and improved function of 83-96% correlated positively with GMFSC, MACS and DASH scores. Noticeable improvement in personal hygienic care was seen in only 52% of cases. Tendon transfer in well-selected spastic upper extremity CP cases results in long-time improved function, and limb appearance - correlating with initial GMFCS and MACS scores.

Impaired glymphatic system revealed by DTI-ALPS in cerebral palsy due to periventricular leukomalacia: relation with brain lesion burden and hand dysfunction

PurposePreterm children with cerebral palsy (CP) often have varying hand dysfunction, while the specific brain injury with periventricular leukomalacia (PVL) cannot quite explain its mechanism. We aimed to investigate glymphatic activity using diffusion tensor image analysis along the perivascular space (DTI-ALPS) method and evaluate its association with brain lesion burden and hand dysfunction in children with CP secondary to PVL.MethodsWe retrospectively enrolled 18 children with bilateral spastic CP due to PVL and 29 age- and sex-matched typically developing controls. The Manual Ability Classification System (MACS) was used to assess severity of hand dysfunction in CP. A mediation model was performed to explore the relationship among the DTI-ALPS index, brain lesion burden, and the MACS level in children with CP.ResultsThere were significant differences in the DTI-ALPS index between children with CP and their typically developing peers. The DTI-ALPS index of the children with CP was lower than that of the controls (1.448 vs. 1.625, P = 0.003). The mediation analysis showed that the DTI-ALPS index fully mediated the relationship between brain lesion burden and the MACS level (c′ = 0.061, P = 0.665), explaining 80% of the effect.ConclusionThis study provides new insights into the neural basis of hand dysfunction in children with CP, demonstrating an important role of glymphatic impairment in such patients. These results suggest that PVL might affect hand function in children with CP by disrupting glymphatic drainage.

Self-care and hand function in preschool children with unilateral or bilateral cerebral palsy: A cross-sectional study.

To describe self-care capabilities among children with cerebral palsy (CP) and explore associations between self-care and hand function for children with unilateral cerebral palsy (UCP) and children with bilateral cerebral palsy (BCP) separately. Cross-sectional data on self-care capabilities (Pediatric Evaluation of Disability Inventory, PEDI), manual abilities (Manual Ability Classification System, MACS) and hand use during bimanual performance (Assisting Hand Assessment, AHA; Both Hands Assessment, BoHA) were retrieved from the Norwegian Quality and Surveillance Registry for Cerebral Palsy (NorCP). Eighty-seven children with CP (UCP, n = 61, mean age 4 years 1month, SD 1 year 3 months, range 56) or BCP (n = 26, mean age 4 years 4 months, SD 1 year, range 41), classified at MACS level I (n = 26), II (n = 40) or III (n =21), were included. No significant differences in self-care capabilities were found between children with UCP and children with BCP. Analysis of variance showed significant differences in self-care between MACS levels for the whole group. No significant differences in self-care between MACS levels were observed for children with UCP (p = 0.36), but significant differences were found for those with BCP (p < 0.001). Whereas a small correlation (r = 0.3) between PEDI and AHA scores was found for children with UCP, a large correlation (r = 0.6) was found for those with BCP. Children with BCP with symmetric hand use during bimanual performance (BoHA) had higher PEDI scores than children with asymmetric hand use. Though children with UCP and children with BCP who were classified at MACS I-III exhibited similar self-care capabilities, the limited hand use seems to contribute differently between the two groups. The two different measures of hand use exhibit different associations with self-care capabilities for young children with UCP and BCP, respectively, and illustrate the need to treat UCP and BCP as two distinct groups, each requiring tailored interventions according to their specific needs.

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 &lt; 0.001) and a moderate to strong correlation between GMFCS and BFMF (r = .618, p &lt; 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.