Bimanual motor performance in everyday life activities of children with hemiplegic cerebral palsy.

Background: Motor impairments in children with cerebral palsy significantly reduce their ability to learn and adapt bimanual actions into their life roles. The current evidence on bimanual coordination performance in children with hemiplegic cerebral palsy were mostly drawn from kinematic studies. Whether these kinematic findings on bimanual motor performance can be observed when performing daily life activities in a natural environment is not clear. Further, there is no evidence what and how the verbal prompting influences bilateral motor performance. We intend to explore its role on bimanual motor performance as well.

Aim: This study aimed to investigate the bimanual motor performance in everyday life activities of children with hemiplegic cerebral palsy and the role of verbal prompts in facilitating affected hand use.

Design: This is an observational study.

Setting: Local medical center and community.

Population: Twenty-five children with hemiplegic cerebral palsy and 25 age-matched typically developing children.

Methods: The Observation-based Test of Capacity, Performance, and Developmental Disregard and Melbourne Assessment 2 were used to assess the quantitative and qualitative use of hands in everyday activities.

Results: Children with hemiplegic cerebral palsy, demonstrated different motor coordination patterns in daily bimanual activities compared with their counterparts. With verbal prompts, children with hemiplegic cerebral palsy significantly increased the use of their affected hands in bimanual activities. However, the increases were observed only in basic motor components, such as reaching and grasping, and not in complex motor components such as manipulation.

Conclusions: These findings will assist researchers and clinicians to develop and refine intervention programs that maximize rehabilitation benefits in improving bimanual hand coordination performance for children with hemiplegic cerebral palsy.

Clinical Rehabilitation Impact: This study increased our understanding of bimanual motor performance of children with hemiplegic cerebral palsy in everyday life activities. The results demonstrated children with cerebral palsy rely more on their less-affected hand to perform bimanual activities with or without verbal prompts. Incorporating bimanual activities and verbal prompts during intervention may only be effective on facilitating basic hand movements but not on improving complex movements of affected hands. Further research is needed to explore other intervention strategies to facilitate complex bilateral hand movements.