Intensive upper extremity training improved whole body movement control for children with unilateral spastic cerebral
Ya-Ching Hung1, Fawzia Shirzad1, Maria Saleem1
1Department of Family, Nutrition, and Exercise Sciences, Queens College, City University of New York, 65-30 Kissena Blvd, Flushing, NY 11367, USA.
Insights
Intensive upper extremity therapies like Constraint-Induced Movement Therapy (CIMT) and Hand-Arm Bimanual Intensive Therapy (HABIT) improved whole-body movement and gait control in children with unilateral spastic cerebral palsy (USCP). Both therapies enhanced coordination and stability during complex tasks.
Area of Science:
- Pediatric Rehabilitation
- Neuroscience
- Movement Science
Background:
- Children with unilateral spastic cerebral palsy (USCP) often have difficulties with bimanual coordination, gait, and overall body movement control.
- While intensive upper extremity training benefits arm function, its impact on whole-body movement control remains unclear.
Purpose of the Study:
- To assess the effects of Constraint-Induced Movement Therapy (CIMT) and Hand-Arm Bimanual Intensive Therapy (HABIT) on bimanual coordination and gait control in children with USCP during whole-body tasks.
Main Methods:
- Sixteen children with congenital hemiplegia (ages 6-12, GMFCS I-II, MACS I-II) were randomized to CIMT or HABIT.
- Training involved 6 hours daily for 15 days, with participants performing walking and tray-carrying tasks.
- 3-D kinematic analysis was used pre- and post-intervention.
Main Results:
- The HABIT group showed improved hand symmetry during tray carrying.
- Both CIMT and HABIT reduced lateral tray motion and increased minimum toe clearance.
- CIMT enhanced walking and tray-carrying speed and stride length.
Conclusions:
- Intensive upper extremity training, including CIMT and HABIT, significantly improves whole-body movement control in children with USCP.
- HABIT specifically enhanced bimanual coordination during whole-body tasks, aligning with the specificity of practice.
- Further research should explore combined upper and lower extremity training benefits.
Background:
Children with unilateral spastic cerebral palsy (USCP) exhibit impaired bimanual coordination, gait control, and whole body movement control. Intensive upper extremity training has been found to be effective for improving upper extremity function. However, the effectiveness of the intensive upper extremity training on whole body movement control is not known.
Research Question:
The present study aimed to evaluate the effects of Constraint Induced Movement Therapy (CIMT) and Hand Arm Bimanual Intensive Therapy (HABIT) on bimanual coordination and gait control during a complex whole body task.
Methods:
Sixteen children with congenital hemiplegia (age 6-12 years; GMFCS: I-II, MACS: I-II) were randomly assigned to either CIMT or HABIT for 6 h per day training for 15 days. Children were asked to perform two whole body tasks (walking with and without a tray carrying) while 3-D kinematic analysis was performed before and after training.
Results:
After training, the HABIT group increased the symmetry in height of their hands during tray carrying (more leveled tray). Both CIMT and HABIT groups decreased the lateral motion of the tray. The CIMT group increased speed and stride length after training in both the walking and tray carrying tasks. Both groups also increased their minimum toe clearance (all p < 0.05).
Significance:
Two types of intensive upper extremity training have provided significant improvements to whole body movement control for children with USCP. Adhering to the specificity of practice concept, HABIT improved bimanual coordination after training during the whole body tray carrying tasks. Given extensive interactions between the upper and lower extremities in real-world activities, future studies should focus on the effects of such combined training.
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