Bimanual hand use in children and adolescents with unilateral spastic cerebral palsy: an exploratory study

Background: Individuals with unilateral spastic cerebral palsy (USCP) often show difficulties using their hands during activities of daily living.Objective: To investigate the factors that interfere with hand use during bimanual activities in children and adolescents with USCP. Methods: We conducted a cross-sectional study with 102 children and adolescents with USCP, aged 6 to 18 years. We collected information with the caregivers about the classification of the child's manual ability, according to the Manual Ability Classification System (MACS); child's age; side of the involvement; Children's Hand-Use Experience Questionnaire-CHEQ2.0. Cluster analysis identified groups of children and adolescents who performed CHEQ activities with or without assistance. Multiple linear regression analyses identified the contribution of the factors: age, sex, MACS level, side of hemiparesis, and clusters of assistance, on the outcomes of efficacy, time, and feeling bothered.Results: MACS and clusters of assistance explained the variance in efficacy (p<0.05; R-2=0.31) and time (p<0.05; R-2=0.37). MACS explained 22% of the variance in feeling bothered. Children and adolescents with increased difficulty to perform activities that involve hand use (i.e., MACS III) and who receive assistance during most bimanual activities showed less efficacy of use, were slower in their performance, and presented greater feeling of being bothered.Conclusion: Assistance in bimanual activities and MACS level contributed to explain the efficacy of use, time, and feeling bothered in performing bimanual activities. Intervention strategies aimed at promoting the performance of bimanual activities in the daily routine of children with USCP should consider these outcomes.