Managing to learn bimanual activities - experiences from children and adolescents with cerebral palsy - a qualitative analysis.

Children and adolescents with cerebral palsy often have impaired hand function. This makes it difficult for them to deal with everyday activities. The aim of the study was to explore the experiences of children and adolescents with unilateral spastic cerebral palsy when it comes to learning and dealing with activities requiring bimanual use. Ten participants, attending mainstream schools, with unilateral spastic cerebral palsy (10-18 years, MACS-level I-III) took part in semi-structured interviews. Qualitative analysis with verbatim transcripts were analysed using a Grounded Theory approach. The learning of bimanual activities was described as a process taking place in interaction with the dynamics of everyday situations. Five categories describing the participants experiences emerged: "Reaching a point where you want to learn", "Awareness and acceptance of your own abilities", "Dealing with the boundaries of the disability", "Dealing with the impact of people around you" and "Strategies for learning". A multi-dimensional theory was derived, summarising how the participants learned bimanual activities in daily life. Children and adolescents with unilateral spastic cerebral palsy express that the process of learning bimanual activities can only take place when it fits in with life as it unfolds. Thus, they have to adapt to a changing context and their own developing skills.Implications for RehabilitationThis study support a person-centred perspective in the process of learning bimanual activities.Interventions need to be tailored to life situations and embedding in child's and adolescents everyday lives.The therapist must be compliant with the child's and adolescents desire for learning.