Development of bimanual performance in young children with cerebral palsy

Abstract

Aim To describe the development of bimanual performance among young children with unilateral or bilateral cerebral palsy (CP). Method A population‐based sample of 102 children (53 males, 49 females), median age 28.5 months (interquartile range [IQR] 16mo) at first assessment and 47 months (IQR 18mo) at last assessment, was assessed half‐yearly with the Assisting Hand Assessment (AHA) or the Both Hands Assessment (BoHA) for a total of 329 assessments. Developmental limits and rates were estimated by nonlinear mixed‐effects models. Developmental trajectories were compared between levels of manual ability (Mini‐Manual Ability Classification System [Mini‐MACS] and MACS) and AHA or BoHA performance at 18 months of age (AHA‐18/BoHA‐18) for both CP subgroups, and additionally between children with bilateral CP with symmetric or asymmetric hand use. Results For both CP subgroups, children classified in Mini‐MACS/MACS level I, and those with high AHA‐18 or BoHA‐18 reached the highest limits of performance. For children with bilateral CP the developmental change was small, and children with symmetric hand use reached the highest limits. Interpretation Mini‐MACS/MACS levels and AHA‐18 or BoHA‐18 distinguished between various developmental trajectories both for children with unilateral and bilateral CP. Children with bilateral CP changed their performance to a smaller extent than children with unilateral CP.