Self-care in children with cerebral palsy and its relationship to manual ability: A longitudinal study

Abstract

Background and Objective(s): To describe the longitudinal development of self-care in children with cerebral palsy (CP) aged 18 months - 60 months across all functional abilities and its relationship to manual ability. To determine the rate and limit of self-care development from 18 months to five years in children with CP according to manual ability. Study Design: Prospective longitudinal population based study. Study Participants & Setting: Two hundred and ninety-one children (179 (62%) male) were recruited from birth years 2004, 2005 (Victoria) and 2006 to 2009 (Queensland) Australia. Children were classified by Manual Ability Classification System (MACS), Gross Motor Function Classification System (GMFCS) and motor type. At the final 60 month appointment, children were classified as MACS Level I=113 (47%), II=61 (25%), III=24 (10%), IV=14 (6%), and V=30 (12%); GMFCS I=111 (46%), II=41 (17%), III=32 (13%), IV=30 (12%), V=28 (12%); unilateral spastic CP=77 (32%), bilateral spastic CP=129 (53%), dystonic CP=12 (5%) ataxic CP=7 (3%), hypotonic CP=6 (3%), athetoid CP=8 (3%). Materials/Methods: Participants entered the study at 18 months corrected age (or later depending on time of diagnosis and referral), and measures were taken at 18, 24, 30, 36, 48 and 60 months of age. Self-care was measured using the Pediatric Evaluation of Disability Inventory (PEDI) Functional Skills Scale. Longitudinal analysis was performed using mixedeffects regression models with self-care trajectories represented as an interaction effect of time and MACS. Results: Children were recruited at 18 (n=75), 24 (n=71), 30 (n=52), 36 (n=45), 48 (n=29) and 60 (n=19) months of age. Participants were seen between 1 and 6 occasions (mean 3.4) with a total of 1065 unique observations. Linear combinations demonstrated that MACS was stable over time from 24 to 60 months, however there was a significant difference in the reported MACS level of children between 18 months and 24 months (t=2.44, 95% CI 1.1-2.5; p=0.015). Between participants there was a MACS variation standard deviation of 1.3, within participants variation was 0.3. Discrete developmental trajectories for self-care over time were found for children in the MACS levels I to V (Figure 1). The estimated change in scaled scores of the self-care domain of the PEDI per month for each of the MACS classification levels was I=0.61, II=0.46, III=0.31, IV=0.16, V=0.03. Conclusions/Significance: This large longitudinal study with a fixed cohort provides information on the rate of self-care development in children with cerebral palsy according to MACS levels. Clinically, these findings can inform goal setting and the likely service requirements needed during early childhood. (Figure Presented).L6184697502017-09-29 <br />