title: Bimanual training and constraint-induced movement therapy in children with hemiplegic cerebral palsy: a randomized trial.
abstract: BACKGROUND
  Constraint-induced movement therapy (CIMT) promotes hand function using intensive unimanual practice along with restraint of the less-affected hand. CIMT has not been compared with a treatment with equivalent dosing frequency and intensity in children with cerebral palsy (CP).
  
  
  OBJECTIVE
  The authors report a randomized trial comparing CIMT and a bimanual intervention (hand-arm intensive bimanual therapy; HABIT) that maintains the intensity of practice associated with CIMT but where children are engaged in functional bimanual tasks.
  
  
  METHODS
  A total of 42 participants with hemiplegic CP between the ages of 3.5 and 10 years (matched for age and hand function) were randomized to receive 90 hours of CIMT or an equivalent dosage of functional bimanual training (HABIT) conducted in day-camp environments. A physical therapist blinded to treatment allocation tested hand function before and after treatment. The primary outcomes were changes in Jebsen-Taylor Test of Hand Function (JTTHF) and Assisting Hand Assessment (AHA) scores. Secondary measures included the Goal Attainment Scale (GAS).
  
  
  RESULTS
  Both the CIMT and HABIT groups demonstrated comparable improvement from the pretest to immediate posttest in the JTTHF and AHA (P < .0001), which were maintained at 6 months. GAS, however, revealed greater progress toward goals for the HABIT group (P < .0001), with continued improvement across test sessions for both groups (P < .0001).
  
  
  CONCLUSIONS
  Both CIMT and bimanual training lead to similar improvements in hand function. A potential benefit of bimanual training is that participants may improve more on self-determined goals.
authors.affiliation: Teachers College, Columbia University, New York, NY 10027, USA. ag275@columbia.edu
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Gordon
authors.forename: Ya-Ching
authors.initials: YC
authors.lastname: Hung
authors.forename: Marina
authors.initials: M
authors.lastname: Brandao
authors.forename: Claudio L
authors.initials: CL
authors.lastname: Ferre
authors.forename: Hsing-Ching
authors.initials: HC
authors.lastname: Kuo
authors.forename: Kathleen
authors.initials: K
authors.lastname: Friel
authors.forename: Electra
authors.initials: E
authors.lastname: Petra
authors.forename: Ashley
authors.initials: A
authors.lastname: Chinnan
authors.forename: Jeanne R
authors.initials: JR
authors.lastname: Charles
mesh_terms: D000704:Analysis of Variance; D002547:Cerebral Palsy / Q000150:complications; D002648:Child; D002675:Child, Preschool; D004185:Disability Evaluation; D005260:Female; D007839:Functional Laterality / Q000502:physiology*; D006225:Hand / Q000503:physiopathology; D006429:Hemiplegia / Q000150:complications / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D009068:Movement / Q000502:physiology; D026201:Musculoskeletal Manipulations / Q000379:methods*; D026741:Physical Therapy Modalities; D012149:Restraint, Physical / Q000379:methods*; D016896:Treatment Outcome