Arm and hand function in infants at risk of Unilateral Spastic Cerebral Palsy and their long-term outcomes

Abstract

Some babies have unilateral brain damage around birth. This can lead to unilateral spastic cerebral palsy (USCP), a condition in which muscle tone on one side of the body is increased, which can limit hand function. Children without USCP but with unilateral brain damage may also have difficulties with hand function, although these are often milder. Using brain MRIs, we are increasingly able to predict which babies are at high risk of developing USCP. Whether a child actually develops USCP is determined using standardized motor assessments. Early identification is important because therapy can then start during a period in which the brain is still highly capable of learning and adapting. This increases the chance of better developmental outcomes. An important early sign is asymmetry in arm and hand movements. With a standardized test of arm and hand function, USCP can be predicted from around 3.5 months of age. Wearable movement sensors on the wrists from this age also appear to be a promising and easy way to measure differences in arm use. In younger babies, this asymmetry may also be present but more subtle. Parents of babies with unilateral brain injury often experience stress and uncertainty during the first year of life. Good guidance from a pediatric physiotherapist and/or occupational therapist, as well as information about their child’s future development, is highly valued by parents. As a result, parents’ confidence in their child’s development and in their own role as parents increases during the first year of life. For the future, it is important to further develop diagnostics using movement assessments. In addition, it is important to develop an intervention program that enables parents to support their child’s development immediately after the diagnosis of unilateral brain injury in their baby.