Executive function and bimanual performance in children with unilateral cerebral palsy

Abstract

Children with unilateral cerebral palsy (CP) experience motor difficulties mainly on one side of their body, affecting activities that require both hands (i.e. bimanual). Some of these children also exhibit impairments in executive functions, which are mental processes regulating daily behavior. Such impairments commonly appear in attention-deficit/hyperactivity disorder (ADHD) or autism spectrum disorder (ASD). This study explores the relation between executive functions in daily life and bimanual function in unilateral CP, while accounting for the role of co-occurring conditions.

Forty-six children (ages 7–15 years) with unilateral CP were classified based on manual ability using the Manual Ability Classification System: 25 at level I (handle objects easily), 15 at level II (handle most objects with reduced quality/speed), and six at level III (handle objects with difficulty, requiring assistance). Bimanual function was assessed with a test requiring bimanual activity and a parent-rated questionnaire, and executive function with a parent-rated questionnaire. Information on co-occurring conditions categorized participants by diagnoses of intellectual disability, ADHD, or ASD. Executive functions were compared to general population scores in all participants, and in subgroups excluding participants with co-occurring intellectual disability, ADHD, or ASD. The study also explored whether executive function differs depending on manual ability levels and ASD diagnosis. Lastly, the relation between executive function and bimanual function was examined.

Executive function difficulties were more common in children with unilateral CP (37%) compared to the general population (15.9%). Excluding those with intellectual disability or ADHD did not change the results, while excluding those with ASD made executive function scores comparable to the general population. Executive function seemed poorer in children with poorer manual ability. Lastly, relations were found between the two parent-rated questionnaires for bimanual function and executive function.