Efficacy of a hand-arm bimanual intensive therapy (HABIT) in children with hemiplegic cerebral palsy: a randomized control trial.
Children with hemiplegic cerebral palsy (CP) have impairments in bimanual coordination above and beyond their unilateral impairments. Recently we developed hand-arm bimanual intensive therapy (HABIT), using the principles of motor learning, and neuroplasticity, to address these bimanual impairments. A single-blinded randomized control study of HABIT was performed to examine its efficacy in children with hemiplegic CP with mild to moderate hand involvement. Twenty children (age range 3 y 6 mo-15 y 6 mo) were randomized to either an intervention (n=10: seven males, three females; mean age 8 y 7 mo, SD 4 y) or a delayed treatment control group (n=10: seven males, three females; mean age 6 y 10 mo, SD 2 y 4 mo). Children were engaged in play and functional activities that provided structured bimanual practice 6 hours per day for 10 days. Each child was evaluated immediately before and after the intervention, and again at 1-month post-intervention. Children in the intervention group demonstrated improved scores on the Assisting Hand Assessment, increased involved extremity use measured using accelerometry and a caregiver survey, bimanual items of the Bruininks-Oseretsky Test of Motor Proficiency, and the simultaneity of completing a draw-opening task with two hands (p<0.05 in all cases). The results suggest that for this carefully selected subgroup of children with hemiplegic CP, HABIT appears to be efficacious in improving bimanual hand use.
Gordon
Andrew M
AM
Division of Physical Therapy, Emory University School of Medicine, Atlanta, GA, USA. ag275@columbia.edu
Schneider
Jennifer A
JA
Chinnan
Ashley
A
Charles
Jeanne R
JR
D001132:Arm / Q000503:physiopathology*; D002547:Cerebral Palsy / Q000503:physiopathology* / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D005081:Exercise Therapy; D005260:Female; D006225:Hand / Q000503:physiopathology*; D006801:Humans; D008297:Male; D026741:Physical Therapy Modalities; D016037:Single-Blind Method