Hand–arm bimanual intensive therapy and daily functioning of children with bilateral cerebral palsy: a randomized controlled trial

Abstract

Aim To examine the efficacy of Hand–Arm Bimanual Intensive Therapy (HABIT) on daily functioning, unimanual dexterity, and bimanual performance of children with bilateral cerebral palsy (CP) compared with customary care. Method Forty‐one children with bilateral CP, aged 4 to 16 years, classified in levels I to III of the Manual Ability Classification System, were randomly assigned to HABIT (90h) (n=21) or to customary care (4.5h) (n=20). Participants’ daily functioning (Pediatric Evaluation of Disability Inventory [PEDI], Canadian Occupational Performance Measure [COPM]), unimanual dexterity (Jebsen–Taylor Test of Hand Function, Box and Blocks Test [BBT]), and bimanual performance (Both Hands Assessment) were assessed pre‐, post‐, and 6 months after the intervention. Linear mixed‐effects models were used for inferential analysis. Results Children participating in HABIT showed greater improvements in daily functioning (COPMperformance: χ12=9.50, p<0.01; COPMsatisfaction: χ12=5.07, p<0.05; PEDIfunctional skills: χ12=6.81, p<0.01; PEDIcaregiver assistance: χ12=6.23, p<0.05) and in the dexterity of the dominant hand (BBT: χ12=3.99, p<0.05) compared with children maintaining customary care. Group or time effects did not explain any variance in bimanual performance or in the dexterity of the non‐dominant hand. Interpretation HABIT may be beneficial for children with bilateral CP, with benefits evidenced for daily functioning outcomes. What this paper adds Hand–Arm Bimanual Intensive Therapy (HABIT) improved daily functioning of children with bilateral cerebral palsy (CP). Bimanual performance, measured by the Both Hands Assessment, did not change after HABIT in children with bilateral CP. Children with asymmetric and symmetric hand use exhibited similar improvements after HABIT.

Measurement properties of the box and block test in children with unilateral cerebral palsy

“…Although the BBT has been widely used to measure the effectiveness of neurorehabilitation programs in children with UCP 7 , 14 , 16 , 17 , only its test–retest reliability and responsiveness have been investigated 18 . The measurement error such as minimal detectable change (MDC, defined as the minimal amount of change that surpasses random measurement error) 19 , the construct validity, and the interpretability such as the minimal clinically important difference (MCID, defined as the minimal change score that is clinically meaningful for the respondents) 20 of the BBT have not been investigated yet in children with UCP.…”

The Effect of Bimanual Intensive Functional Training on Somatosensory Hand Function in Children with Unilateral Spastic Cerebral Palsy: An Observational Study

“…The satisfaction scores of the COPM increased significantly immediately after BIMT, though a slight decrease was observed at six months follow-up. A recent report by Figueiredo et al [ 43 ] showed similar results in a group of children with bilateral CP participating in an intensive 90 h bimanual training program called HABIT. The group that performed the program exhibited greater improvements in performance and satisfaction with the performance of functional goals and functional skills than children who maintained their customary care routines and are following the results found by Bleyenheuft et al [ 44 ].…”

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

“…The full texts of the remaining 174 papers were screened, revealing that 25 articles did not compare the protocol of interest with another upper limb manual training, 14 were study protocols, 15 were not published yet, 5 included pretreatment with botulinum toxin, 11 were dose-effect studies, 19 had the duplicated study group, 23 were not peer-reviewed articles, 19 were not randomized controlled trials, 3 included participants who did not have cerebral palsy, 10 with data unassessable, 5 did not illustrate functional outcomes, and 3 used combination therapy. Finally, 22 articles 7,11,[30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49] were selected for this network meta-analysis (Figure 1).…”