title: Hand and Arm Bimanual Intensive Therapy Including Lower Extremity (HABIT-ILE) in Children With Unilateral Spastic Cerebral Palsy: A Randomized Trial.
abstract: BACKGROUND
  Intensive bimanual training results in more improvement in hand function in children with unilateral spastic cerebral palsy (USCP) than lower intensity conventional interventions. However, it is not known whether combined upper and lower extremity training in an intensive protocol is more efficacious for upper and lower functional abilities than conventional therapies provided in usual customary care.
  
  
  OBJECTIVE
  To determine the efficacy of Hand and Arm Bimanual Intensive Therapy Including Lower Extremity (HABIT-ILE) for children with USCP.
  
  
  METHODS
  Twenty-four children with USCP were randomized into 2 groups: an immediate HABIT-ILE group (IHG, initially receiving HABIT-ILE, 10 days = 90 hours), and a delayed HABIT-ILE group (DHG), which continued their conventional/ongoing treatment for an intended total duration of 90 hours. In phase 2, children in the DHG were crossed over to receive HABIT-ILE and children of the IHG were followed in their ongoing conventional therapy. Children were assessed using the Assisting Hand Assessment (AHA, primary outcome), the ABILHAND-Kids, and the Pediatric Evaluation of Disability Inventory. Dexterity (Box and Blocks Test [BBT]) and pinch strength were also measured. Locomotor abilities were assessed with Six-Minute Walk Test (6MWT, primary outcome) and ABILOCO-kids. Social participation was measured with the Assessment of Life-HABITs.
  
  
  RESULTS
  A 2 (groups) × 3 (test sessions) analysis of variance indicated significant improvements for primary outcomes (AHA, P < .001; 6MWT, P = .002) and all secondary assessments except BBT, step length and bodyweight distribution following HABIT-ILE, but not conventional therapy.
  
  
  CONCLUSIONS
  The findings suggest that combined upper and lower extremity in an intensive training protocol may be efficacious for improving both upper and lower extremity function in children with USCP.
authors.affiliation: Institue of Neuroscience, Université catholique de Louvain, Brussels, Belgium yannick.bleyenheuft@uclouvain.be.
authors.forename: Yannick
authors.initials: Y
authors.lastname: Bleyenheuft
authors.affiliation: Physical and Occupational Therapy Department, Paramedical Category, Haute Ecole Louvain en Hainaut, Montignies-sur-Sambre, Belgium.
authors.forename: Carlyne
authors.initials: C
authors.lastname: Arnould
authors.affiliation: Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil.
authors.forename: Marina B
authors.initials: MB
authors.lastname: Brandao
authors.affiliation: Institue of Neuroscience, Université catholique de Louvain, Brussels, Belgium CHU Mont-Godinne, Yvoir, Belgium.
authors.forename: Corrine
authors.initials: C
authors.lastname: Bleyenheuft
authors.affiliation: Teachers College, Columbia University, New York, NY, USA.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Gordon
mesh_terms: D000293:Adolescent; D002547:Cerebral Palsy / Q000534:rehabilitation*; D002648:Child; D004185:Disability Evaluation; D005260:Female; D007839:Functional Laterality / Q000502:physiology*; D018737:Hand Strength / Q000502:physiology; D006801:Humans; D035002:Lower Extremity / Q000503:physiopathology*; D008297:Male; D026741:Physical Therapy Modalities; D012919:Social Behavior; D034941:Upper Extremity / Q000502:physiology*
keywords: bimanual training; cerebral palsy; children; dose; gait; hand; hemiplegia; intensive training; lower extremity rehabilitation; motor skill learning; neurorehabilitation; posture; upper extremity rehabilitation