Hand Function in a Population-Based Sample of Young Children with Unilateral or Bilateral Cerebral Palsy

ABSTRACT

Aim: To describe aspects of hand function in a population-based sample of young children with clinical signs of unilateral or bilateral cerebral palsy (CP). Method: A cross-sectional study with data from national CP registers in Norway. Manual ability was classified with the Manual Ability Classification System (MACS) or Mini-MACS. Hand use in bimanual activities was measured with the Assisting Hand Assessment (AHA) for unilateral CP or the newly developed Both Hands Assessment (BoHA) for bilateral CP. Results: From 202 children, 128 (57 females) were included (Mini-MACS/MACS levels I–V, mean age 30.4 months; SD = 12.1). Manual abilities were distributed across levels I–III in unilateral CP and levels I–V in bilateral CP. Variations in AHA and BoHA units were large. One-way ANOVA revealed associations between higher AHA or BoHA units and Mini-MACS/MACS levels of higher ability (p < 0.01) and higher age (p < 0.04). Conclusions: Compared with young children with unilateral CP, children with bilateral CP showed greater variation in Mini-MACS/MACS levels, and both sub-groups showed large variations in AHA or BoHA units. The classifications and assessments used in this study are useful to differentiate young children's ability levels. Such information is important to tailor upper limb interventions to the specific needs of children with CP.

KEYWORDS:

• Assisting hand assessment
• bimanual performance
• both hands assessment
• cerebral palsy
• child
• hand function

Acknowledgments

We would like to thank all the children and parents for participating in the study. Moreover, we would like to thank all the project co-workers in the regional pediatric rehabilitation units for recruiting children to the study of Habilitation Trajectories, Interventions and Services for Preschool Children with Cerebral Palsy (CPHAB), and the OTs for their contributions with the AHA and BoHA data. Particularly, we would like to thank Sandra J. Hollung and Guro L. Andersen for their help with retrieving and recoding data from CPRN, and Ann-Kristin Elvrum for supervision in the scoring of the BoHA videos. Finally, we acknowledge the contributions of the CPOP.

Declaration of Interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article. Lena Krumlinde-Sundholm is involved in the company Handfast AB, which provides courses in the Assisting Hand Assessment and the Both Hands Assessment. The company has not been involved in, or has not funded, any part of this research.

Funding

The study was funded by the Norwegian Research Council (NRC) as a PhD fellowship to Gunvor L. Klevberg through the Research Center for Habilitation and Rehabilitation Models and Services (CHARM) at the University of Oslo (UiO).

About the Authors

Gunvor L. Klevberg, MA, OT, is a PhD student at the Research Centre for Habilitation and Rehabilitation Models and Services (CHARM) at the Faculty of Medicine, University of Oslo, Norway. Sigrid Østensjø, PhD, PT, is an Associate Professor at the Master program in Rehabilitation and Habilitation at the Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Norway. Lena Krumlinde-Sundholm, PhD, OT, is an Associate Professor in the Neuropediatric Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden. Sonja Elkjær, MSc, OT, is the Coordinator in the Cerebral Palsy follow-up Program (CPOP) in the Department of Neurosciences for Children at Oslo University Hospital, Norway. Reidun B. Jahnsen, PhD, PT, is a Senior Researcher and leader of the Cerebral Palsy follow-up Program (CPOP) in the Department of Neurosciences for Children at Oslo University Hospital, Norway.