Daily-life executive functions and bimanual coordination in children with unilateral cerebral palsy: a cross-sectional study using robotic and caregiver-reported measures

BACKGROUND: Children with unilateral cerebral palsy (uCP) frequently experience bimanual coordination difficulties. Executive functions (EFs), which support goal-directed behavior, may be associated with these difficulties. This study investigated the relation between daily-life EFs and goal-directed bimanual coordination in children with uCP by examining the effects of EFs and age on coordination, and associations between EF domains and bimanual coordination. PARTICIPANTS & METHODOLOGY: Bimanual coordination was assessed in 46 children with uCP (mean age 11.1 ± 2.1 years) and 56 typically developing children (mean age 11.7 ± 2.8 years), through three tasks of the Kinarm exoskeleton involving target reaching, ball interception, circuit navigation. Data from typically developing children were used to establish age-predictive norms for bimanual coordination. Daily-life EFs in children with uCP were assessed using the Behavior Rating Inventory of Executive Function, classifying them as typical EFs (n = 21) and below-average EFs (n = 25). Group differences in impairments were examined using Fisher's exact tests, while multiple linear regressions estimated the effects of EF group and age on bimanual coordination; sensitivity analyses excluding children with co-occurring conditions were additionally performed for these models. Spearman correlations (rₛ) explored associations between daily-life EFs and bimanual coordination. RESULTS: Children with below-average EFs showed more bimanual coordination impairments in seven parameters (p ≤ 0.045). Sensitivity analyses showed similar patterns. EF group effects were found for five bimanual parameters (R² up to 0.24), favoring the typical EF group; two parameters improved with increasing age (R² up to 0.30). Low-to-moderate correlations were found between daily-life EFs and bimanual coordination (rₛ up to 0.56). CONCLUSIONS: These findings suggest that daily-life EFs are associated with bimanual coordination variability in uCP. Clinically, they highlight the importance of considering cognitive abilities during assessment and incorporating cognitive demands within bimanual rehabilitation approaches in uCP.