Fine Motor Skills in Children with Acquired Hydrocephalus After Shunting

Abstract

Background: Hydrocephalus is a neurological condition characterized by abnormal accumulation of cerebrospinal fluid within the brain ventricles, leading to elevated intracranial pressure and potential motor and cognitive deficits. Although ventriculoperitoneal shunting remains the standard treatment, its effect on fine motor function especially in children with acquired hydrocephalus remains unclear. Understanding these outcomes is critical for guiding rehabilitation and long-term care. Objective: To evaluate fine motor skills in children with acquired hydrocephalus after shunting and to examine the association between impairment and demographic or clinical factors. Methods: This observational cross-sectional study was conducted from March 2023 to March 2024 at the Children’s Hospital and the Institute of Child Health, Lahore. Thirty-five children aged 4–14 years with acquired hydrocephalus post-shunting were assessed using the Bimanual Fine Motor Classification System (BMFCS), Manual Ability Classification System (MACS), and Nine-Hole Peg Test. Demographic and clinical variables were recorded. Associations between fine motor impairment and patient factors were analyzed using Chi-square tests, with p < 0.05 considered significant. Results: Fine motor impairment was identified in 6 children (17.1%), while 29 (82.9%) showed no impairment. Most participants scored at Level 1 or 2 on both BMFCS (85.8%) and MACS (82.9%), and 82.9% performed the pegboard test easily. No statistically significant associations were found between impairment and age (p = 0.724), etiology (p = 0.672), cause (p = 0.615), timing of first shunt (p = 0.925), shunt revision (p = 0.373), or adjuvant therapy (p = 0.578). Conclusion: The majority of children with acquired hydrocephalus maintain good fine motor function after shunting, independent of demographic or procedural factors. Routine fine motor assessment and targeted occupational therapy should be incorporated into post-shunt care to optimize functional outcomes.