Hand Function in 8- to 12-Year-Old Children with Bilateral Cerebral Palsy and Interpretability of the Both Hands Assessment

Abstract

Aim

To describe bimanual performance in a sample of Australian children with bilateral cerebral palsy (CP) and, examine the qualitative meaning (or interpretability) of scores on the Both Hands Assessment (BoHA).

Methods

Children with bilateral CP aged 8–12 years (n = 54) classified Manual Ability Classification System (MACS) level I = 20, II = 18, III = 16 were examined using the BoHA.

Results

Bimanual performance was significantly different across MACS levels I-III (p < 0.001). Mean (95%CI) BoHA-unit for each MACS level were I = 85 (81–89), II = 72 (68–76) and III = 53 (49–56). Children with asymmetrical hand use (≥ 20% difference between upper limbs, n = 10) were classified MACS levels II and III and had a mean (95%CI) BoHA-unit of 56 (51–62). Children with symmetrical hand use were classified in MACS level I-III and had a mean (95%CI) BoHA-unit of 74 (70–79).

Conclusions

The BoHA quantified observations of bimanual performance for children with bilateral CP, differentiated between MACS levels I-III and provided clinically meaningful information. The BoHA may facilitate tailoring of upper limb intervention. Future research is recommended to examine inter-rater and intra-rater reliability and responsiveness of the BoHA, as well as longitudinal studies of bimanual hand skill development in children with bilateral CP.

Keywords:

• Both Hands Assessment (BoHA)
• cerebral palsy
• children
• hand function
• measurement
• upper limb activity performance

Acknowledgements

The authors give thanks to Dr Ann Kristin Elvrum for giving of her time and expertise to provide feedback to Andrea Burgess on her rating of five videos used in this study.

Disclosure statement

The authors report that no financial interest or benefit has arisen from the applications of this research.

Correction Statement

This article has been republished with minor change. This change do not impact the academic content of the article.

Additional information

Funding

This project was supported by the National Health and Medical Research Council (NHMRC) under grant Predict-CP 1077257; Australian Government Research Training scholarship (AB); Children Hospital Foundation – Lola Hughes Efstathis Top-Up scholarship (AB); NHMRC CDF1 Fellowship (LS 1160694); Children’s Hospital Foundation Mary McConnel Career Boost for Women (LS); and NHMRC Research Fellowship (RB 1037220)

Notes on contributors

Andrea Burgess

Andrea Burgess is an Occupational Therapist and PhD student in the Faculty of Medicine at The University of Queensland. Her research has focused on the development of self-care skills and hand function in children with cerebral palsy.

Roslyn Nancy Boyd

Roslyn Nancy Boyd is Professor of Cerebral Palsy Research at the Queensland Cerebral Palsy and Rehabilitation Research Centre the Faculty of Medicine at the University of Queensland. Prof Boyd's research focuses on the early detection and early intervention for infants with Cerebral Palsy in high and low resource settings.

Mark David Chatfield

Mark David Chatfield is a Senior Biostatistician in the Faculty of Medicine at The University of Queensland. He has worked with the co-authors researching cerebral palsy since 2018.

Jenny Ziviani

Jenny Ziviani is Professor of Occupational Therapy in the School of Health and Rehabilitation Sciences at The University of Queensland. Her research focuses on family centred interventions for children with developmental disabilities, their motivational components, and how to enhance therapeutic engagement.

Leanne Sakzewski

Leanne Sakzewski is an Associate Professor at the Queensland Cerebral Palsy and Rehabilitation Research Centre at The University of Queensland. Her research focuses on novel interventions to improve motor, social and participation outcomes of infants, children and adolescents with cerebral palsy and acquired brain injuries.