title: The Effect of Bimanual Training with or Without Constraint on Hand Functions in Children with Unilateral Cerebral Palsy: A Non-Randomized Clinical Trial.
abstract: OBJECTIVE
  To compare the effect of bimanual training with or without constraint on manual functions in children with unilateral cerebral palsy (UCP).
  
  
  METHODS
  Seventeen children aged 6-11 years with UCP participated in one of two intensive therapeutic camps: bimanual (n = 9) incorporating one hour of constraint ("Hybrid") or Bimanual (n = 8). Each camp met for 2 weeks, 5 days per week for 6 hours each day. The Assisting Hand Assessment (AHA) and the Jebsen Taylor Test of Hand Function (JTTHF) examined bimanual and unimanual functions pre, post- and 3-months post-intervention.
  
  
  RESULTS
  A significant improvement was noted in AHA scores for both groups between the pre-, post- and three months post-intervention [Hybrid (F2; 16 = 85.5, p < 0.01); Bimanual (F2; 16 = 15.4, p < 0.01)] with no significant differences between groups over time (F2; 30 = 0.74, p = 0.48). For the JTTHF, a significant improvement was noted in the affected hand following the Hybrid program (F2; 30 = 7.45, p = 0.01), while following the Bimanual program a significant difference was noted only in the less-affected hand (F2; 16 = 6.02, p < 0.01].
  
  
  CONCLUSIONS
  Both interventions Hybrid and Bimanual were similarly effective for improving use of the affected hand in bimanual tasks. The unique contribution of each intervention, the Hybrid program on the affected and the Bimanual on the less-affected side, warrants further examination.
authors.affiliation: a Pediatric and Adolescent Rehabilitation Center , Alyn Hospital , Jerusalem , Israel.
authors.forename: Marilyn
authors.initials: M
authors.lastname: Cohen-Holzer
authors.affiliation: a Pediatric and Adolescent Rehabilitation Center , Alyn Hospital , Jerusalem , Israel.|b Physical Therapy Department, School of Health Professions, Faculty of Medicine , Tel Aviv University , Ramat Aviv , Israel.
authors.forename: Michal
authors.initials: M
authors.lastname: Katz-Leurer
authors.affiliation: a Pediatric and Adolescent Rehabilitation Center , Alyn Hospital , Jerusalem , Israel.
authors.forename: Shirley
authors.initials: S
authors.lastname: Meyer
authors.affiliation: c Center for Rehabilitation , Oxford Brookes University , Oxford , United Kingdom.
authors.forename: Dido
authors.identifier: http://orcid.org/0000-0002-1129-8071
authors.initials: D
authors.lastname: Green
authors.affiliation: d School of Occupational Therapy , Faculty of Medicine of Hadassah and the Hebrew University of Jerusalem , Jerusalem , Israel.
authors.forename: Shula
authors.initials: S
authors.lastname: Parush
mesh_terms: D002547:Cerebral Palsy / Q000534:rehabilitation*; D002648:Child; D003131:Combined Modality Therapy / Q000379:methods; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006225:Hand / Q000503:physiopathology*; D006801:Humans; D008297:Male; D009048:Motor Skills / Q000502:physiology*; D012149:Restraint, Physical / Q000379:methods; D016896:Treatment Outcome
keywords: Bimanual; combined; constraint; motor learning; unilateral cerebral palsy