Background
Neurorehabilitation interventions in children with unilateral cerebral palsy (UCP) target motor abilities in daily life yet deficits in hand skills persist. Limitations in the less-affected hand may impact overall bimanual hand skills.
Objective
To compare hand function, by timed motor performance on the Jebsen-Taylor Test of Hand Function (JTTHF) and grip strength of children with UCP to children with typical development (CTD), ages 8–18 years old. Exploratory analyses compared hand function measures with respect to neurophysiological outcomes measured by transcranial magnetic stimulation and between group comparisons of hemispheric motor threshold.
Methods
Baseline hand skills were evaluated in 47 children (21 UCP; 26 CTD). Single-pulse transcranial magnetic stimulation testing assessed corticospinal tract and motor threshold.
Results
The mean difference of the less-affected hand of children with UCP to the dominant hand of CTD on the JTTHF was 21.4 seconds [95% Confidence Interval = 9.32, 33.46, p=0.001]. The mean difference in grip strength was −30.8 N [−61.9, 0.31, p = 0.052]. Resting motor thresholds between groups were not significant, but age was significantly associated with RMT (p<0.001; p=0.001). Children with UCP ipsilateral pattern of motor representation demonstrated greater mean differences between hands than children with contralateral pattern of motor representation (p<0.001). All results adjusted for age and sex.
Conclusions
The less-affected hand in children with UCP underperformed the dominant hand of CTD. Limitations were greater in children with UCP ipsilateral motor pattern. Rehabilitation in the less-affected hand may be warranted. Bilateral hand function in future studies may help identify the optimal rehabilitation and neuromodulatory intervention.