Hand use development in children with unilateral cerebral palsy

Aim To describe the development of hand use during bimanual activities among children with unilateral cerebral palsy (CP). Method A cohort of 166 children (79 females, 87 males; age range 18mo–13y, mean [SD] age at first assessment 37.6mo [20.5mo]) with unilateral CP, registered in the Norwegian CP Follow-up Program with two or more Assisting Hand Assessments (AHAs), were included in this longitudinal study comprising 524 AHAs. Developmental limits and rates were estimated by non-linear mixed effects models and compared between a stable limit model (SLM) and a peak and decline model. Development was described according to Manual Ability Classification System (MACS) levels and AHA performance at 18 months of age (AHA-18). Results Children in MACS level I, or in the high AHA-18 group, reached highest limits and had the most rapid development (p