title: Intensive upper- and lower-extremity training for children with bilateral cerebral palsy: a quasi-randomized trial.
abstract: OBJECTIVE
  An approach that simultaneously engages both the upper and lower extremities, hand-arm bimanual intensive therapy including lower extremity (HABIT-ILE), has recently demonstrated improvements in upper and lower extremities in children with unilateral cerebral palsy (CP). It is not known whether children with bilateral CP would benefit from this approach. The aim of this study was to examine the efficacy of HABIT-ILE in children with bilateral CP.
  
  
  METHODS
  A quasi-randomized trial design was used, whereby 20 participants (age 6-15y, Gross Motor Function Classification System levels II-IV, Manual Ability Classification System levels I-III) were assigned to a treatment (HABIT-ILE) or a comparison group in the order in which they were enrolled. Children in the HABIT-ILE group were assessed before and after 84 hours of intervention over 13 days, as well as at 3 months' follow-up. Children in the comparison group were assessed at the same time points. Children in both groups were assessed using the Gross Motor Function Measure (GMFM-66) and ABILHAND-Kids (primary measures), and six secondary measures.
  
  
  RESULTS
  A group×test session interaction indicated significant improvements in the HABIT-ILE group as assessed by the GMFM-66, lower-extremity performance (6-Minute Walk Test; Pediatric Balance Scale), functional upper-extremity abilities (ABILHAND-Kids/Pediatric Evaluation of Disability Inventory), and the dexterity of the less affected upper extremity.
  
  
  CONCLUSIONS
  HABIT-ILE is efficacious for improving both upper- and lower-extremity function in children with bilateral CP.
authors.affiliation: Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium.
authors.forename: Yannick
authors.initials: Y
authors.lastname: Bleyenheuft
authors.affiliation: Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium.
authors.forename: Daniela
authors.initials: D
authors.lastname: Ebner-Karestinos
authors.affiliation: Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA.
authors.forename: Bhavini
authors.initials: B
authors.lastname: Surana
authors.affiliation: Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium.
authors.forename: Julie
authors.initials: J
authors.lastname: Paradis
authors.affiliation: Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA.
authors.forename: Alexis
authors.initials: A
authors.lastname: Sidiropoulos
authors.affiliation: Physical and Rehabilitation Medicine Department, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium.
authors.forename: Anne
authors.initials: A
authors.lastname: Renders
authors.affiliation: Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA.|Burke-Cornell Medical Research Institute, White Plains, NY, USA.
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Friel
authors.affiliation: Departamento de Terapia Ocupacional, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
authors.forename: Marina
authors.initials: M
authors.lastname: Brandao
authors.affiliation: Research in Function and Rehabilitation, Rehabilitation Medicine, CAPHRI, Maastricht University, Maastricht, the Netherlands.|Center of Expertise, Adelante Rehabilitation, Hoensbroek, the Netherlands.|Avans Plus, Breda, the Netherlands.
authors.forename: Eugene
authors.initials: E
authors.lastname: Rameckers
authors.affiliation: Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Gordon
mesh_terms: D000293:Adolescent; D001132:Arm / Q000503:physiopathology; D002547:Cerebral Palsy / Q000503:physiopathology / Q000534:rehabilitation*; D002648:Child; D005081:Exercise Therapy; D005260:Female; D005500:Follow-Up Studies; D007839:Functional Laterality; D006225:Hand / Q000503:physiopathology; D006801:Humans; D035002:Lower Extremity / Q000503:physiopathology; D008297:Male; D009043:Motor Activity; D010865:Pilot Projects; D004856:Postural Balance; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D000070857:Walk Test; D016138:Walking