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

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Section: Discussionmentioning

confidence: 99%

Development of bimanual performance in young children with cerebral palsy

Klevberg

Elvrum

Zucknick

et al. 2018

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“…34 Conversely, two studies observing outcomes in bimanual performance in children with unilateral and bilateral impairments assessed with the Assisting Hand Assessment and the Both Hands Assessment 32,35 showed similar results in both groups. Although our results on the responsiveness are similar between both groups (improvement after intervention), the mean values at each assessment differed between groups, showing the specificity of each topography.…”

Section: Responsivenessmentioning

confidence: 91%

Reliability and responsiveness of the Jebsen‐Taylor Test of Hand Function and the Box and Block Test for children with cerebral palsy

Araneda

Ebner‐Karestinos

Paradis

et al. 2019

METHOD In this retrospective study, the reliability analyses were conducted with paired t-tests considering a short (mean 14d) and a long (mean 120d) time in between two assessment periods. In addition, an intraclass correlation coefficient (ICC) was used to assess the level of congruency. The responsiveness to therapy was conducted with a paired t-test in the whole sample regarding the age, the manual ability level as classified with the Manual Ability Classification System (MACS), and the topography. RESULTSOur main results confirmed the tests' reliability in a short time period for the JTTHF in both hands and for the BBT on the less affected hand. These results were consistent with the ICC. The responsiveness was confirmed, except on the less affected hand for the JTTHF, with similar results for age, MACS, and topography approach.INTERPRETATION This study supports the use of the JTTHF and the BBT to examine changes after short-term interventions for children with CP. These results should be interpreted with association to normative values or with a control group when used over long assessment periods.

“…However, the focus of these interventions is usually on the effects on the lower limbs rather than the upper limbs. Thus, knowledge about interventions to improve upper limb function in children with bilateral CP is limited …”

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confidence: 99%

“…2 More than 60% of children with bilateral CP have impaired hand function. 5 Manual ability among these children is typically classified within all levels of the Manual Ability Classification System (MACS), 6 including the more severe MACS levels IV and V, 5,7 whereas children with unilateral CP are usually classified within MACS levels I to III. In children with CP, limited ability to manipulate objects with the hands is reported as one of the strongest predictors of limitations in everyday activities and participation restrictions.…”

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confidence: 99%

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Interventions to improve upper limb function for children with bilateral cerebral palsy: a systematic review

Plasschaert

Vriezekolk

Aarts

et al. 2019

AimTo systematically review the efficacy of interventions on upper limb function in children 0 to 19 years of age with bilateral cerebral palsy on the basis of outcome measures of upper limb function and measures of activities and/or participation according to the International Classification of Functioning, Disability and Health.MethodCochrane, PubMed, Embase, CINAHL, and Web of Science were searched from inception to September 2017. Methodological quality and strength of evidence were analysed by two independent raters using Sackett's level of evidence and the American Academy for Cerebral Palsy and Developmental Medicine (AACPDM) guidelines.ResultsFifteen studies with a large variety of interventions and heterogeneity in outcome measures met the inclusion criteria. Twelve studies provided level IV evidence according to AACPDM guidelines. For three small randomized controlled trials the level of evidence was II. Only one of these trials showed strong methodological quality: a study on hand–arm bimanual intensive therapy including lower extremities.InterpretationWe identified a large variety of interventions, heterogeneity in outcome measures, and generally weak to moderate methodological quality for most studies. We recommend further research specifically aimed at bimanual‐intensive, goal‐directed, and task‐specific training programmes for the upper limb in children with bilateral cerebral palsy, using either high‐quality (multicentre) trials or well‐designed single‐case trials.What this paper adds There is a large variety of interventions on upper limb function in children with bilateral cerebral palsy.Heterogeneity of outcome measures and interventions impeded firm conclusions about intervention efficacy.Most studies had low‐level evidence and weak to moderate methodological quality.The strongest evidence from a small randomized controlled trial was for hand–arm bimanual intensive therapy including lower extremities.