Short summary

Background: Infant with CP benefit from an early intervention. Impaired hand function can be identified from the age of 3.5 months in infant at risk of CP. Knowledge about the development of hand use are needed to support the treatment planning and for prognostic use. Aim: To describe the development of hand use in infants with CP. Method: A prospective longitudinal design. About 50 infant at risk of CP are expected to be followed with repeated motor assessments from the age of 4-18 month.

Rationale

Introduction

Impaired hand function is found to be a strong predictor of limited participation in activities of everyday life in children with cerebral palsy (CP). Therefore, improving these children's ability to use their hands is a treatment goal of most importance.

CP is the most common cause of physical disability in children. Based on the average number of birth in the region of Southern Denmark, where this study takes place, it is estimated that 20 children will be diagnosed with CP per year. CP can affect one side of the body (unilateral CP) or both sides (bilateral CP). About 70 % of children with CP have an impaired hand function that limit their performance of activities of daily life.

Early infancy is characterized by great motor development due to large neural plasticity in the infant's brain. This probably makes this period highly suitable for therapy interventions. As the diagnosis of CP often cannot be made with certainty the first year of life, infants at risk of CP must be identified in early age to ensure timely and targeted intervention. About hand use, clinical signs of impaired hand function can be identified from the age of 3.5 months, by using the new tool Hand Assessment for Infants (HAI).

The HAI is an observation based test of upper limb function in infants aged 3.5 - 12 month. The HAI test is validated to infants with unilateral CP, but according to the developers of the test, the HAI may also be useful to children with bilateral CP.

Knowledge about the development of the use of hands in children with CP is important to support treatment planning and for prognostic use. Several longitudinal studies have been made, describing the hand function development in children with CP, but they do not include the youngest children. Only one study describes the trajectories of hand function development in children with CP ages 3-12 month using the HAI-test (Sakzewski L, et al. 2019). However, this study does not include infants with bilateral CP or other assessment tools than HAI, which could provide additional knowledge to practice. Furthermore, former studies have shown that bimanual performance measured at the age of 18 months, using the test Assisting Hand Assessment (AHA) or MACS-level, may predict future development of bimanual performance (Holmefur M et al 2010, Nordstrand L et al 2016, Klevberg GL et al 2018). Therefore, knowledge about any relation between measurements at 18 month and the HAI scores will be usefull in the treatment planning.

Thus, to support treatment planning the aim of this study are to describe aspects of the development of hand use in infants with cerebral palsy (CP) aged 4-18 month.

Description of the cohort

Participants are recruited from the four hospitals in the region of Southern Denmark, where infants at risk of CP routinely are followed.

Parents of all identified infants meeting the inclusion criteria are invited to participate in the study.

Inclusion criteria:

Infants aged 3.5-5 months, where pre-term factors indicate risk of developing CP (cranial ultrasound (C-US) or magnetic resonance imaging (MRI) findings) or clinical signs of deceased or asymmetric use of hands (e.g. using the test general Movement). Exclusion criteria: In need of an interpreter. Infants diagnosed with a syndrome.

Data and biological material

Background information (medical journal record):

Gender, gestational age (term (GA> 36), preterm (GA= 32-36), very pre-term (GA< 28-31), extreme pre-term (GA< 28)), brain lesion (grey matter, white matter, mal-development, other), impaired vision, epilepsy, siblings, twins, confirmation of the diagnosis of CP.

Primary measurement:

Hand Assessment for Infants (HAI).

Assisting Hand Assessment (AHA)

Both Hand Assessment (BoHA)

The Mini-Manual Ability Classification System (Mini-MACS)

Secondary measurement:

PDMS-2: Peabody Developmental Motor Scale Gross Motor Function Classification System (GMFCS)

Pedi: Pediatric Evaluation of Disability Inventory, Danish version.

Collaborating researchers and departments

Børne og ungeafdelingen, Sygehus Lillebælt, Børne og ungeafdelingen Sygehus Sønderjylland, Børne og ungeafdelingen Sygehus Vestjylland.