Effectiveness of Hand-Arm Bimanual Intensive Therapy on Hand Function among Children with Unilateral Spastic Cerebral Palsy: A Meta-Analysis

Alahmari, Khalid A.; Tedla, Jaya Shanker; Sangadala, Devika Rani; Mukherjee, Debjani; Bairapareddy, Kalyana Chakravarthy; Kandakurti, Praveen Kumar

doi:10.1159/000507325

Cited by 4 publications

(5 citation statements)

References 22 publications

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“…Alahmari et al ( 46 ) considered four RCTs, about bimanual therapy (duration of intervention 60–90 h for 2–4 weeks) in hemiplegic subjects. A meta-analysis on the efficacy (measured using the Jebsen-Taylor Hand Function Test—JTHFT) of HABIT vs. CIMT or structured and unstructured bimanual therapies was conducted: HABIT showed a trivial effect compared to the other interventions, with an effect size of 0.06.…”

Section: Resultsmentioning

confidence: 99%

Evidence-based management and motor rehabilitation of cerebral palsy children and adolescents: a systematic review

Faccioli,

Pagliano,

Ferrari

et al. 2023

Front. Neurol.

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BackgroundEvidence regarding the management of several aspects of cerebral palsy improved in recent years. Still, discrepancies are reported in clinical practice. Italian professionals and stakeholders expressed the need of setting up updated, evidenced-based, shared statements, to address clinical practice in cerebral palsy rehabilitation. The objective of the present study was to provide an updated overview of the state of knowledge, regarding the management and motor rehabilitation of children and young people with cerebral palsy, as the framework to develop evidence-based recommendations on this topic.MethodsGuidelines and systematic reviews were searched, relative to evidence-based management and motor treatment, aimed at improving gross motor and manual function and activities, in subjects with cerebral palsy, aged 2–18 years. A systematic search according to the Patients Intervention Control Outcome framework was executed on multiple sites. Independent evaluators provided selection and quality assessment of the studies and extraction of data.ResultsFour guidelines, 43 systematic reviews, and three primary studies were included. Agreement among guidelines was reported relative to the general requirements of management and motor treatment. Considering the subject's multidimensional profile, age and developmentally appropriate activities were recommended to set individual goals and interventions. Only a few approaches were supported by high-level evidence (i.e., bimanual therapy and constraint-induced movement therapy to enhance manual performance). Several task-specific active approaches, to improve gross motor function and gait, were reported (mobility and gait training, cycling, backward gait, and treadmill), based on low-level evidence. Increasing daily physical activity and countering sedentary behavior were advised. Based on the available evidence, non-invasive brain stimulation, virtual reality, action-observation therapy, hydrotherapy, and hippotherapy might be complementary to task or goal-oriented physical therapy programs.ConclusionA multiple-disciplinary family-centered evidence-based management is recommended. All motor rehabilitation approaches to minors affected by cerebral palsy must share the following fundamental characteristics: engaging active involvement of the subject, individualized, age and developmentally appropriate, goal-directed, skill-based, and preferably intensive and time-limited, but suitable for the needs and preferences of the child or young person and their family, and feasible considering the implications for themselves and possible contextual limitations.

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Section: Resultsmentioning

confidence: 99%

Evidence-based management and motor rehabilitation of cerebral palsy children and adolescents: a systematic review

Faccioli,

Pagliano,

Ferrari

et al. 2023

Front. Neurol.

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“…11 Hand–arm bimanual intensive training is a complex technique in which the patient uses the affected extremity along with the less-affected extremity in a symmetrical or alternating movement pattern that simulates most activities of daily living. 10 Constraint-induced movement therapy constrains the less-affected limb while intensively training the affected limb to enhance hand function. 10,54 The modified constraint-induced movement therapy protocol was developed as an alternative to the intensive nature of constraint-induced movement therapy.…”

Section: Discussionmentioning

confidence: 99%

“…10 Constraint-induced movement therapy constrains the less-affected limb while intensively training the affected limb to enhance hand function. 10,54 The modified constraint-induced movement therapy protocol was developed as an alternative to the intensive nature of constraint-induced movement therapy. 13 These protocols may be an alternative training strategy for children with cerebral palsy.…”

Section: Discussionmentioning

confidence: 99%

“…8,9 Different upper limb manual training protocols have been proposed to help these children develop better functional skills. Hand-arm bimanual intensive therapy, 10 hand-arm bimanual intensive training including lower extremity, 11 constraintinduced movement therapy, 10,12 modified constraint-induced movement therapy, 13 action observation therapy, 14 and mirror therapy 15 are all common training protocols. Although these approaches may effectively improve children's functional skills, no study has compared all of these strategies.…”

Section: Introductionmentioning

confidence: 99%

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Upper limb manual training for children with cerebral palsy: A systematic review and network meta-analysis of randomized controlled trials

et al. 2022

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Objective There are different upper limb manual training protocols, namely constraint-induced movement therapy, modified constraint-induced movement therapy, hand–arm bimanual intensive training, hand–arm bimanual intensive training including lower extremity, action observation training, and mirror therapy, available for improving functional outcomes in children with cerebral palsy. However, the effect and priority of these strategies remain unclear. Data sources We searched the PubMed, Cochrane Library, and Embase databases for relevant articles from inception to October 12, 2022. Review methods To assess the effect and priority of different strategies of upper limb manual training protocols through a systematic review and network meta-analysis of randomized controlled trials. Results We included 22 randomized controlled trials in this network meta-analysis. The ranking probability and standard mean differences with 95% credible intervals of the comparison between placebo and other forms of upper limb manual training were as follows: mirror therapy = 2.83 (1.78, 3.88), hand–arm bimanual intensive training including the lower extremity = 0.53 (0.09, 0.96), constraint-induced movement therapy = 0.44 (0.18, 0.71), hand–arm bimanual intensive training = 0.41 (0.15, 0.67), modified constraint-induced movement therapy = 0.39 (0.03, 0.74), and action observation training = 0.18 ( − 0.29, 0.65). No significant inconsistency was noted between the results of direct and indirect comparisons. Conclusion We suggest that mirror therapy could be the upper limb manual training protocol of choice for improving functional outcomes in patients with cerebral palsy.

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“…[20][21][22][23][24] The two most extensively investigated contemporary approaches include modified Constraint Induced Movement Therapy (mCIMT) 25 26 and Hand Arm Bimanual Intensive Therapy (HABIT). [27][28][29] Although both of these interventions have shown to be efficacious in improving unimanual and bimanual hand function, respectively, they require higher training doses (60-90 hours training within 2-3 weeks), have modest effect sizes, poor retention of training effects, and are highly variable in treatment efficacy across individuals. 26 30 31 Thus, clinical utility of these interventions is limited.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

Remote ischaemic conditioning combined with bimanual task training to enhance bimanual skill learning and corticospinal excitability in children with unilateral cerebral palsy: a study protocol of a single centre, phase II randomised controlled trial

Surkar,

Willson,

Cassidy

et al. 2023

BMJ Open

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IntroductionChildren with unilateral cerebral palsy (UCP) have difficulty in bimanual coordination that restricts the child’s independence in daily activities. Although several efficacious interventions to improve bimanual coordination exist, these interventions often require higher training doses and have modest effect sizes. Thus, there is a critical need to find an effective priming agent that, when paired with task-specific training, will facilitate neurobiological processes to enhance the magnitude of training effects and subsequently improve functional capabilities of children with UCP. The aim of this study is to determine the effects of a novel priming agent, remote ischaemic conditioning (RIC), combined with bimanual training on bimanual skill learning and corticospinal excitability in children with UCP.Methods and analyses46 children, aged 8–16 years, will be randomly assigned to receive RIC or sham conditioning combined with 5 days of bimanual skill (cup stacking) training (15 trials per session). RIC or sham conditioning will be performed with a standard conditioning protocol of five cycles of alternative inflation and deflation of a pressure cuff on the affected arm with the pressure of at least 20 mm Hg above systolic blood pressure for RIC and 25 mm Hg for sham conditioning. Primary outcomes will be movement time and corticospinal excitability measures determined with a single-pulse transcranial magnetic stimulation (TMS). Secondary outcomes include Assisting Hand Assessment, spatio-temporal kinematic variables and paired pulse TMS measures. All measures will be conducted before and immediately after the intervention. A mixed model analysis of variance will test the group×time interaction for all outcomes with group (RIC and sham) as between-subject and time (preintervention, postintervention) as within-subject factors.Ethics and disseminationThe study has been approved by the University Medical Centre Institutional Review Board (UMCIRB #21-001913). We will disseminate the study findings via peer-reviewed publications and presentations at professional conferences.Trial registration numberNCT05777070

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Effectiveness of Hand-Arm Bimanual Intensive Therapy on Hand Function among Children with Unilateral Spastic Cerebral Palsy: A Meta-Analysis

Cited by 4 publications

References 22 publications

Evidence-based management and motor rehabilitation of cerebral palsy children and adolescents: a systematic review

Evidence-based management and motor rehabilitation of cerebral palsy children and adolescents: a systematic review

Upper limb manual training for children with cerebral palsy: A systematic review and network meta-analysis of randomized controlled trials

Remote ischaemic conditioning combined with bimanual task training to enhance bimanual skill learning and corticospinal excitability in children with unilateral cerebral palsy: a study protocol of a single centre, phase II randomised controlled trial

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