Daily-life executive functions and bimanual performance in children with unilateral cerebral palsy

Abstract

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.