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Self‐care and manual ability in preschool children with cerebral palsy: a longitudinal study
Author(s) -
Burgess Andrea,
Boyd Roslyn N,
Ziviani Jenny,
Ware Robert S,
Sakzewski Leanne
Publication year - 2019
Publication title -
developmental medicine and child neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.658
H-Index - 143
eISSN - 1469-8749
pISSN - 0012-1622
DOI - 10.1111/dmcn.14049
Subject(s) - cerebral palsy , longitudinal study , medicine , pediatrics , population , psychology , physical therapy , environmental health , pathology
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.