Dexterity of the Less Affected Hand in Children With Hemiplegic Cerebral Palsy

BACKGROUND: To determine if the "unaffected" hand in children with hemiplegic cerebral palsy (CP) is truly unaffected.

METHODS: We performed a retrospective review of manual dexterity as measured by the Functional Dexterity Test (FDT) in 66 children (39 boys, 27 girls, mean age: 11 years 4 months) with hemiplegic CP. Data were stratified by Manual Ability Classification System (MACS) level, birth weight, and gestational age at birth, and compared with previously published normative values.

RESULTS: The FDT speed of the less affected hand is significantly lower than typically developing (TD) children ( P < .001). The development of dexterity is significantly lower than TD children (0.009 vs. 0.036 pegs/s/year, P < .001), with a deficit that increases with age. MACS score, birth weight, and age at gestation are not predictors of dexterity. The dexterity of the less affected hand is poorly correlated with that of the more affected hand.

CONCLUSIONS: Both dexterity and rate of fine motor skill acquisition in the less affected hand of children with hemiplegic CP is significantly less than that of TD children. The less affected hand should be evaluated and included in comprehensive treatment plans for these children.