Self‐care and manual ability in preschool children with cerebral palsy: a longitudinal study

Abstract

Aim To describe longitudinal development of self‐care and its relationship to manual ability in children with cerebral palsy (CP) aged 18 months to 5 years across all functional abilities. Method This was a prospective longitudinal population‐based study of 290 children with CP (178 [61%] males, 112 [39%] females). Self‐care was assessed using the Pediatric Evaluation of Disability Inventory (PEDI). At 60 months (n=242), children were classified using the Manual Ability Classification System (MACS); 113 in level I (47%), 61 in MACS level II (25%), 24 in MACS level III (10%), 14 in MACS level IV (6%), and 30 in MACS level V (12%). Measures were taken at 18 months, 24 months, 30 months, 36 months, 48 months, and 60 months of age. Longitudinal analyses were performed using mixed‐effects linear regression models. Results Self‐care development achieved by 60 months was negatively associated with the severity of manual ability impairment. Distinct self‐care developmental trajectories were found with estimated changes in PEDI self‐care scaled scores per month: 0.61 for MACS level I, 0.46 for MACS levels II, 0.31 for MACS level III, 0.16 for MACS level IV, and 0.03 for MACS level V. Children classified in MACS level V had the lowest level of self‐care skills at 18 months and showed no progress in self‐care development. Interpretation This study reports rate of self‐care development in preschool children with CP. Self‐care performance was highest in children with greatest manual ability. Clinicians may use rates of change to predict or monitor self‐care performance. PEDI trajectories inform goal setting in discussions with families regarding expected levels of independence in self‐care. What this paper adds Distinct self‐care developmental trajectories in children with cerebral palsy were found according to Manual Ability Classification System (MACS) levels. Children in MACS levels IV and V with epilepsy did not show any significant change in self‐care. Children in MACS levels IV and V without epilepsy demonstrated small yet significant gains in self‐care performance.

Upper limb strength training and somatosensory stimulation: optimizing self‐care independence for children with unilateral cerebral palsy

“…Most daily life activities require the skilled use of both hands to complete such tasks. Higher levels of self‐care independence are indeed reported in children with better manual abilities . Mastering self‐care further enables the child to participate in home, school, and leisure activities.…”

“…Higher levels of self-care independence are indeed reported in children with better manual abilities. 1 Mastering self-care further enables the child to participate in home, school, and leisure activities. Therefore, the ultimate goal of the clinician is to optimize the child's functional potential to improve performance in daily life.…”

Developmental trajectory of self‐care in children with cerebral palsy with different manual abilities

“…present results from a longitudinal population‐based study and have added valuable information regarding self‐care developmental trajectories for preschool children with CP with different manual abilities . Based on the association between MACS levels and Pediatric Evaluation of Disability Inventory (PEDI) self‐care scores, the authors reported the rate of self‐care development across different MACS levels with clear radar charts, with self‐care skills achieved at 5 years old …”

“…The strengths of this study were the use of the large population‐based longitudinal data and radar charts that presented clearly how much self‐care skill improved for preschool children at different MACS levels. Moreover, the strong correlation between GMFCS and MACS levels reported suggest that self‐care skills were not only associated with MACS levels, but with GMFCS levels .…”

“…Firstly, the developmental trajectories were for children with CP under the age of 5 years. According to the radar charts, children did not achieve complete independence in some skills (such as tying shoelaces, zipping and unzipping, and drying bodies) even at MACS level I. Therefore, it is unknown when children with CP will fully acquire these skills.…”