Early developmental trajectories of the impaired hand in infants with unilateral cerebral palsy

Abstract

We looked at the developmental trajectories (which describes the progression of a given behaviour as individuals age) of impaired hand function in 63 infants with unilateral cerebral palsy. We assessed hand function using the Hand Assessment for Infants either two or three times between 3- and 15-months corrected age. The Hand Assessment for Infants measures the degree and quality of goal-directed actions performed with each hand separately and both hands together.

We used group-based trajectory modelling which has been developed to determine subgroups within a given population. We found there were three distinctly different trajectories for low, moderate, and high functioning infants.

There were 23 infants (35%) in the moderate group and 22 (36%) in the high functioning group. Eighteen infants (29%) were in the low functioning group and showed no appreciable change in hand function between 3- and 15-months corrected age, despite all receiving early targeted upper limb training, either modified constraint-induced movement therapy or bimanual therapy. Infants born closer to term equivalent age were at a higher risk of being in the low compared to high functioning group.