Aim: The aim of the study was to describe the development of hand function, particularly the use of the affected hand in bimanual tasks, among children with unilateral cerebral palsy aged 18 months to 12 years.

Method: A convenience sample of 96 children (53 males, 43 females) was assessed with the Assisting Hand Assessment (AHA) at regular intervals from the ages of 18 months to 12 years. The children ranged from 17 to 127 months (median age 24mo) at recruitment. Subgroups were created to identify differences in development using the child’s AHA at 18 months and the Manual Ability Classification System (MACS). A nonlinear mixed effects model was used to analyze data according to a ‘stable limit’ development model.

Results: The results were based on 702 AHA sessions. The children showed a rapid development at a young age and reached 90% of their stable limit between 30 months and 8 years. The subgroups, based on the 18-month AHA and the MACS levels respectively, had distinctly different patterns of development.

Interpretation: The AHA at 18 months may be used to make a crude prediction of future development.

Aim: To investigate the validity of the internet-based version of the Children's Hand-use Experience Questionnaire (CHEQ) by testing the new four-category rating scale, internal structure, and test-retest reliability.

Method: Data were collected for 242 children with unilateral cerebral palsy (CP) (137 males and 105 females; mean age 9y 10mo, SD 3y 5mo, range 6-18y). Twenty children from the study sample (mean age 11y 8mo, SD 3y 10mo) participated in a retest within 7 to 14 days. Validity was tested by Rasch analysis based on a rating scale model and test-retest reliability by Kappa analysis and intraclass correlation coefficient (ICC).

Results: The four-category rating scale was within recommended criteria for rating scale structure. One item was removed because of misfit. CHEQ showed good scale structure according to the criteria. The effective operational range was >90% for two of the CHEQ scales. Test-retest reliability for the three CHEQ scales was: grasp efficacy, ICC=0.91; time taken, ICC=0.88; and feeling bothered, ICC=0.91.

Interpretation: The internet-based CHEQ with a four-category rating scale is valid and reliable for use in children with unilateral CP. Further studies are needed to investigate the validity of the internet-based version of CHEQ for children with upper limb reduction deficiency or obstetric brachial plexus palsy and the validity of the recommended improvements to the current version.

The common assumption that early-onset intensive intervention positively affects motor development has rarely been investigated for hand function in children with unilateral cerebral palsy (CP). This retrospective study explored the possible impact of baby constraint-induced movement therapy (baby-CIMT) on hand function at two years of age. We hypothesized that baby-CIMT in the first year of life would lead to better bimanual hand use at two years of age than would not receiving baby-CIMT. The Assisting Hand Assessment (AHA) was administered at age 21 months (SD 2.4 months) in 72 children with unilateral CP, 31 of who received baby-CIMT. When dividing the children into four functional levels based on AHA, the proportional distribution differed between the groups in favour of baby-CIMT. Logistic regression analysis indicated that children in the baby-CIMT group were more likely than were children in the no baby-CIMT group to have a high functional level, even when controlling for the effect of brain lesion type (OR 5.83, 95% CI 1.44-23.56, p = 0.001). However, no difference was found between groups in the odds of having a very low functional level (OR 0.31, 95% CI 0.08-1.17, p = 0.084). The result shows that baby-CIMT at early age can have a positive effect. Children who received baby-CIMT were six times more likely to have a high functional level at two years of age than were children in the no baby-CIMT group.

Aim: There is evidence that modified Constraint-Induced Movement Therapy (mCIMT) has a short-term positive effect on hand function in children with unilateral cerebral palsy (CP), but the long-term effect is unknown. The aim was to investigate whether or not a single block of mCIMT (2 hours/day during 2 months) at age 2-3 years influences the course of development of bimanual hand function at about 8 years of age.

Methods: A convenience sample of 45 children (girls, n = 21) with unilateral CP and mean age 32 months was included (mCIMT group, n = 26; reference group, n = 19). Brain lesion characteristics were available for 32 children. The children were measured repeatedly with the Assisting Hand Assessment (AHA) for a mean period of 4 years and 6 months. Development curves were created and compared with a non-linear mixed effects model.

Results: Children receiving mCIMT had an upper limit of development that was 8.5 AHA units higher than the reference group (p = 0.022). When controlling for brain lesion characteristics and baseline in a subgroup of 32 children, the difference was considerably smaller and no longer significant.

Conclusion: mCIMT might have a positive impact on long-term development, but the results are inconclusive. 

The Assessment of Capacity for Myoelectric Control (ACMC) is an observation-based clinical tool that evaluates ability to control a myoelectric prosthetic hand during bimanual activities. Two validity aspects were investigated: potential bias interaction between prosthesis users and activities performed during assessment, and potential bias interaction between activities and different user characteristics (sex or prosthetic side). Six activities were standardized for the ACMC. Upper-limb myoelectric prosthesis users (47 congenital, 11 acquired; 31 male, 27 female, average age 19.9 yr) performed three standardized activities, each on one occasion. Bias-interaction analysis in the many-facet Rasch model identified inconsistent patterns in the interactions of individual users and activity facets and between activities and user characteristics. The standardized activities had no significant influence on measures of user ability. The activities functioned similarly across both sexes (p-value greater than or equal to 0.12) and across both prosthetic sides in persons with upper-limb reduction deficiency (p-value greater than or equal to 0.50) and persons with acquired amputation (p-value greater than or equal to 0.13). The results provide evidence for the validity of the ACMC across the standardized activities and support use of the ACMC in prosthesis users of both sexes and prosthetic sides. The newly standardized activities are recommended for future ACMC use.

BACKGROUND: Much variation is found in the development of hand function in children with unilateral cerebral palsy (CP).

OBJECTIVE: To explore how anatomic brain abnormalities can be used to predict the development of hand function.

METHODS: A total of 32 children with unilateral CP (16 boys and 16 girls) were evaluated at least once a year by the Assisting Hand Assessment (AHA). The data collection covered an age range from 18 months to 8 years (mean time in study, 4 years and 6 months). Computerized tomography or magnetic resonance imaging of the brain were assessed for patterns of brain damage, including the location of gray and extent of white-matter damage. The children were divided into groups according to lesion characteristics, and a series of univariate models were analyzed with a nonlinear mixed-effects model. The rate and maximum limit of development were calculated.

RESULTS: The highest predictive power of better development of hand function was the absence of a concurrent lesion to the basal ganglia and thalamus, independent of the basic type of brain lesion. This model predicted both the rate of increasing ability and hand function at age 8 years. Hand function was also predicted by the basic pattern of damage and by the extent of white-matter damage. The presence of unilateral or bilateral damage had no predictive value.

CONCLUSIONS: Neuroradiological findings can be used to make a crude prediction of the future development of the use of the affected hand in young children with unilateral CP.

Introduction: There is evidence that Constraint-Induced Movement Therapy (CIMT) has a short-term positive effect on hand function in children with unilateral cerebral palsy (CP). Secondary analysis from previous study of development of hand function was performed with the aim to investigate whether one period of CIMT (at age 2–3y) influences the course of development or not.

Participants and Methods: A convenience sample of 45 children with unilateral CP was included at mean age 32 months (CIMT-group, n=24, non-CIMT group n=21) and mean age at start of intervention was 28.2 months. The children were measured repeatedly, at least once a year with the Assisting Hand Assessment (AHA) for a mean period of 4 years and 6 months. A non-linear mixed effects model was used to create and compare development curves for the CIMT and non-CIMT groups.

Results: Children who had CIMT had an upper limit of development that was 8,1 AHA-units higher than the children who had not have CIMT (p=0.028). Also when controlling for brain lesion characteristics there was a difference in limit of development in favour of the CIMTgroup, although not significant. Children with lower AHA-score at 18 months had seemed to gain more from CIMT than children with a higher AHA-score.

Conclusion: This study shows that one period of CIMT at age 2–3 years in children with unilateral CP is associated with better development of hand function regardless of brain lesion characteristics. This is the first study describing long-term effects of CIMT.

Earlier studies of development of hand function showed large variation between individuals in course of development.

Aim: To identify factors that predict or correlate with development of hand function in children with unilateral cerebral palsy (CP).

Methods: Forty-five children with unilateral CP (inclusion age 18-64 months) were measured repeatedly with the Assisting Hand Assessment over on average 4,5 years. Data was collected on brain lesion (n=27), learning ability, sensibility in affected hand etc. A non-linear mixed models analysis was used.

Results: Type, extent and location of brain lesion could predict development of hand function. Decreased learning ability was a predictor of slower development of hand function. Poor sensibility in the affected hand correlated with slower development and a lower ability level compared to children with good sensibility.

Conclusion: Development of hand function can be predicted by brain lesion and is correlated to learning ability and sensibility in the affected hand.