title: Caregiver-directed home-based intensive bimanual training in young children with unilateral spastic cerebral palsy: a randomized trial.
abstract: OBJECTIVE
  To examine the efficacy of caregiver-directed, home-based intensive bimanual training in children with unilateral spastic cerebral palsy (USCP) using a randomized control trial.
  
  
  METHODS
  Twenty-four children (ages 2y 6mo-10y 1mo; 10 males, 14 females) performed home-based activities directed by a caregiver for 2 hours per day, 5 days per week, for 9 weeks (total=90h). Cohorts of children were age-matched into groups and randomized to receive home-based hand-arm bimanual intensive therapy (H-HABIT; n=12) or lower-limb functional intensive training (LIFT-control; n=12). Caregivers were trained before the intervention and supervised remotely via telerehabilitation. Dexterity and bimanual hand function were assessed using the Box and Blocks test (BBT) and the Assisting Hand Assessment (AHA) respectively. Caregiver perception of functional goals was measured using the Canadian Occupational Performance Measure (COPM).
  
  
  RESULTS
  H-HABIT showed greater improvement on the BBT compared to LIFT-control and no improvement on the AHA. H-HABIT demonstrated significant improvement in COPM-Performance compared to LIFT-control and both groups showed equal improvement in COPM-Satisfaction.
  
  
  CONCLUSIONS
  H-HABIT improved dexterity and performance of functional goals, but not bimanual performance, in children with USCP compared to a control group receiving intervention of equal intensity/duration that also controlled for increased caregiver attention. Home-based models provide a valuable, family-centered approach to achieve increased treatment intensity.
authors.affiliation: Burke-Cornell Medical Research Institute, White Plains, NY, USA.|Biobehavioral Sciences Department, Teachers College, Columbia University, New York, NY, USA.
authors.forename: Claudio L
authors.initials: CL
authors.lastname: Ferre
authors.affiliation: Occupational Therapy Department, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
authors.forename: Marina
authors.initials: M
authors.lastname: Brandão
authors.affiliation: Biobehavioral Sciences Department, Teachers College, Columbia University, New York, NY, USA.
authors.forename: Bhavini
authors.initials: B
authors.lastname: Surana
authors.affiliation: Department of Rehab Services, Ochsner Health System, New Orleans, LA, USA.
authors.forename: Ashley P
authors.initials: AP
authors.lastname: Dew
authors.affiliation: Department of Physical Therapy, School of Allied Health Professions, LSU Health Sciences, New Orleans, LA, USA.
authors.forename: Noelle G
authors.initials: NG
authors.lastname: Moreau
authors.affiliation: Biobehavioral Sciences Department, Teachers College, Columbia University, New York, NY, USA.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Gordon
mesh_terms: D017028:Caregivers; D002547:Cerebral Palsy / Q000150:complications*; D002648:Child; D002675:Child, Preschool; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D007839:Functional Laterality / Q000502:physiology*; D006225:Hand / Q000503:physiopathology*; D006699:Home Care Services; D006801:Humans; D035002:Lower Extremity / Q000503:physiopathology; D008297:Male; D009128:Muscle Spasticity / Q000209:etiology* / Q000534:rehabilitation*; D017063:Outcome Assessment, Health Care