title: A multi-site study of functional outcomes following a themed approach to hand-arm bimanual intensive therapy for children with hemiplegia.
abstract: OBJECTIVE
  This study investigated the effects of a theme-based ('magic') variation of the hand-arm bimanual intensive therapy programme, in two different countries, in improving activity performance for children with hemiplegia, including those with severe movement restrictions.
  
  
  METHODS
  Twenty-three children with spastic hemiplegia (13 males, 10 females; mean age 10y 7mo, range 7-15y; Manual Ability Classification System level I, two; level II, 13; level III, eight), participated in one of three, 2-week, summer camps. A within-participant experimental design was used with the Assisting Hand Assessment and Children's Hand Experience Questionnaire as primary outcome measures. Evaluations occurred immediately before the first day, on the last day, and 3 months after intervention. Two groups underwent additional assessments 2 weeks before the camp.
  
  
  RESULTS
  Significant intervention effects were seen on the Assisting Hand Assessment (p=0.002) and on the Children's Hand Experience Questionnaire (p<0.001), the latter maintained at follow-up. The affected hand was reported to be used in 25% of bimanual activities before the camp, progressing to 93% after camp, and decreasing to 86% at follow-up. Severity of impairment did not influence progress.
  
  
  CONCLUSIONS
  This themed approach to intensive intervention showed positive results in bimanual use, with improvements in independence sustained at follow-up. Although children across camps and motor severity made progress, some questions remain about intensity and duration of intervention to optimize longer-term outcomes.
authors: Department of Occupational Therapy, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors: Dido
authors: D
authors: Green
authors: Mitchell
authors: M
authors: Schertz
authors: Andrew M
authors: AM
authors: Gordon
authors: Amarlie
authors: A
authors: Moore
authors: Tamara
authors: T
authors: Schejter Margalit
authors: Yvonne
authors: Y
authors: Farquharson
authors: Dafna
authors: D
authors: Ben Bashat
authors: Maya
authors: M
authors: Weinstein
authors: Jean-Pierre
authors: JP
authors: Lin
authors: Aviva
authors: A
authors: Fattal-Valevski
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001132:Arm / Q000503:physiopathology*; D002648:Child; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D007839:Functional Laterality; D006225:Hand / Q000503:physiopathology*; D006429:Hemiplegia / Q000503:physiopathology* / Q000523:psychology / Q000534:rehabilitation*; D006801:Humans; D007557:Israel; D008297:Male; D009042:Motivation; D009048:Motor Skills; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D006113:United Kingdom