Getting a grip on hand use in unilateral cerebral palsy

Contains fulltext : 162525.pdf (publisher's version ) (Open Access)Motor impairments of the affected upper limb in children with Unilateral Cerebral Palsy (UCP) compromise the effective use of the arm and hand to grasp, hold, manipulate and release objects. The execution of bimanual activities in daily life is hampered. However, even when upper limb motor control is fairly good, there are children with UCP that show a marked discrepancy between their upper limb capacity (‘what they cán do’) and their daily life performance (‘what they actually do’). This ‘underuse’ of the affected upper limb is referred to as ‘developmental disregard’ (DD). A novel treatment approach was developed to improve upper limb capacities, optimize bimanual coordination, and decrease DD with the ultimate goal to improve the performance of daily activities. In this intervention Constraint Induced Movement Therapy (CIMT) was combined with Bimanual Training (BiT) to enhance the transfer of improved upper limb movements into age-appropriate bimanual activities. The (long term) effectiveness of this CIMT-BiT approach in a playful group intervention for young children (2.5 to 8 years), as well as the progression of manual dexterity, were investigated in a RCT. In the CIMT-BiT protocol for older children with UCP (aged 8 to 18 years) was augmented with self-management training, in order to reinforce the children to independently monitor the efficient use of their affected hand during daily life activities without being prompted by adults. Feasibility and effectiveness were examined. Part two of this thesis addresses upper limb assessment in UCP. In this part the revisions of two observational scales (Modified House Classification (MHC) and the Video-Observation-Aarts-and-Aarts - Determine Developmental Disregard (VOAA-DDD), respectively) are described and the clinimetric properties of the revised versions are examined. The third study presents the development of the Hand-Use-at-Home Questionnaire for parents, as well as the examination of its internal structure, unidimensionality and validity.Radboud University, 20 januari 2017Promotores : Geurts, A.C.H., Steenbergen, B. Co-promotor : Aarts, P.B.M