The effects of postural control and upper extremity functional capacity on functional Independence in preschool-age children with spastic cerebral palsy: a path model

Purpose To investigate the effects of postural control and upper extremity functional capacity on functional independence and identify whether quality of upper extremity skills mediates the effects of postural control on functional independence in preschool-age children with spastic cerebral palsy (CP). Methods 106 children with CP -mean age 43.4 +/- 11.3 (24-71 months)- were included in this cross-sectional study. Postural control, upper extremity functional capacity, and functional independence in activities of daily living were evaluated using the Early Clinical Assessment of Balance (ECAB), Quality of Upper Extremity Skills Test (QUEST), and the Functional Independence Measure of Children (WeeFIM), respectively. A path model was used to evaluate the total, direct, and indirect effects. Results According to the path model, ECAB (direct effect; r = 0.391, p < 0.01, indirect effect; r = 0.398) and QUEST (direct effect; r = 0.493, p < 0.01) had an impact on WeeFIM. In addition, QUEST had mediating effects on the relationship between ECAB and WeeFIM. The path model explained 71% of the variation in functional independence of the participants. Conclusion In the management of CP in preschool-age children, the focus should be on improving not only upper extremity capacity but also postural control to help improve functional independence in activities of daily living.