Preschool-to-school-age changes in daily-life upper-limb activity and hand function outcomes in children with unilateral cerebral palsy: a secondary longitudinal follow-up study

Objective To compare within-child changes in daily-life bilateral wrist actigraphy and standardized and caregiver-reported hand function outcomes from preschool to school age in children with unilateral cerebral palsy (UCP).Methods This secondary longitudinal observational study linked harmonized pre-intervention assessment waves from two prospective upper-limb rehabilitation trials. Thirteen children with UCP who participated in both studies and had complete actigraphy and hand-function outcome data at both T0 assessments were included. At each wave, MACS level was determined from contemporaneous information on the child’s usual manual performance, and children underwent 3-day bilateral wrist actigraphy during habitual daily life and standardized assessment with the Assisting Hand Assessment (AHA) and Melbourne Assessment 2 (MA2), together with caregiver report using the Pediatric Motor Activity Log-Revised (PMAL-R).Results The mean follow-up interval was 3.82 ± 0.37 years (range, 2.91–4.36 years), and all 13 children retained their baseline MACS level at follow-up reassessment. Mean participant-level percentage changes in less-affected, affected, and bilateral activity counts were −20.2%, −23.6%, and −21.5%, respectively (all p < .001). No statistically detectable group-level change was observed in magnitude ratio (p = .273), AHA scores (p = .635), or PMAL-R How Often scores (p = .068). Mean PMAL-R How Well and all MA2 domain scores were higher at follow-up (all p ≤ .021).Conclusions In this secondary follow-up sample, mean daily-life upper-limb activity counts were lower at follow-up, whereas no statistically detectable group-level change was observed in magnitude ratio or AHA scores; mean PMAL-R How Well and MA2 domain scores were higher at follow-up. These findings suggest that absolute movement volume and relative interlimb use may reflect different patterns of between-wave change. Reductions in raw activity counts should therefore be interpreted cautiously in the context of treatment exposure, maturation, and changes in daily routines and environments.Trial registration The parent trials were registered at ClinicalTrials.gov (NCT04904796 and NCT06272760).