Daily‐life executive functions and bimanual performance in children with unilateral cerebral palsy
Alexandra Kalkantzi, Lize Kleeren, Dieter Baeyens, Lisa Decraene, Monica Crotti, Katrijn Klingels, Anja Van Campenhout, Geert Verheyden, Els Ortibus, Hilde Feys, Lisa MailleuxAbstract
Aim
To explore daily‐life reported executive functions and their relation with bimanual performance in children with unilateral cerebral palsy (CP).
Method
In this cross‐sectional study of 46 children with unilateral CP (mean age 11 years 10 months, standard deviation 2 years 10 months), executive functions were evaluated using the Behavior Rating Inventory of Executive Function (BRIEF) and bimanual performance with the Assisting Hand Assessment (AHA) and Children's Hand‐use Experience Questionnaire (CHEQ). One‐sample z‐tests were used to compare participants' executive functions with population norms, while taking autism spectrum disorder (ASD, n = 16) as a comorbidity into account. Moreover, we used regression analysis to estimate the effect of manual ability (Manual Ability Classification System levels: I = 25, II = 15, III = 6) and having a comorbid diagnosis of ASD on executive functions (p < 0.05, R2). Lastly, non‐parametric correlations (rs, p < 0.05) were calculated between the BRIEF, CHEQ, and AHA.
Results
In general, executive functions in children with unilateral CP were poorer compared with the normative mean (p ≤ 0.024). However, when excluding participants with ASD, no difference compared with the normative mean was found. A significant effect of manual ability was found for Inhibition (p = 0.042), while ASD effects were found for most of the BRIEF subscales (p ≤ 0.001). Multiple significant correlations were found between the BRIEF and CHEQ (rs = −0.50 to −0.29), while only the BRIEF subscale Inhibition was significantly correlated with the AHA (rs = −0.35).
Interpretation
A higher number of children with unilateral CP exhibit difficulties in daily‐life executive functions, which appear to be mainly co‐occurring with ASD. Manual ability was a significant factor of inhibition‐related behavioural challenges. Furthermore, there seems to be a relation between impaired executive functions and decreased bimanual performance. The findings emphasize the importance of further research, including performance‐based assessments of executive functions in children with unilateral CP.