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Caregiver-directed home-based intensive bimanual training in young children with unilateral spastic cerebral palsy: a
Claudio L Ferre1,2, Marina Brandão3, Bhavini Surana2
1Burke-Cornell Medical Research Institute, White Plains, NY, USA.
Insights
Caregiver-directed home-based hand-arm bimanual intensive therapy (H-HABIT) improved dexterity and functional goal performance in children with unilateral spastic cerebral palsy (USCP). However, it did not enhance bimanual hand function.
Area of Science:
- Pediatric Rehabilitation
- Neuroscience
- Occupational Therapy
Background:
- Unilateral spastic cerebral palsy (USCP) often impacts upper extremity function, necessitating effective therapeutic interventions.
- Home-based, caregiver-directed therapies offer a scalable approach to intensive training for children with USCP.
- Optimizing bimanual hand function and overall dexterity is crucial for functional independence in children with USCP.
Purpose of the Study:
- To evaluate the efficacy of home-based hand-arm bimanual intensive therapy (H-HABIT) compared to a lower-limb functional intensive training (LIFT) control in children with USCP.
- To assess the impact of H-HABIT on dexterity, bimanual hand function, and caregiver-perceived functional goals.
Main Methods:
- A randomized control trial involving 24 children with USCP (ages 2y 6mo-10y 1mo) was conducted.
- Participants were randomized to receive 90 hours of H-HABIT or LIFT-control over 9 weeks, with caregiver direction and remote supervision.
- Dexterity (Box and Blocks test) and bimanual function (Assisting Hand Assessment) were primary outcomes; caregiver-perceived goals (Canadian Occupational Performance Measure) were secondary.
Main Results:
- H-HABIT demonstrated significantly greater improvements in dexterity (Box and Blocks test) compared to the LIFT-control group.
- No significant difference in bimanual hand function (Assisting Hand Assessment) was observed between the H-HABIT and LIFT-control groups.
- H-HABIT led to significant improvements in caregiver-perceived functional goal performance (Canadian Occupational Performance Measure), with similar satisfaction levels in both groups.
Conclusions:
- Home-based intensive bimanual therapy (H-HABIT) effectively enhances dexterity and functional goal achievement in children with USCP.
- While H-HABIT shows promise, it did not significantly improve overall bimanual hand function in this study.
- Family-centered, home-based models are valuable for delivering intensive, effective interventions for pediatric cerebral palsy, emphasizing the importance of caregiver involvement and telerehabilitation.
Aim:
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.
Method:
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.
Interpretation:
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.
