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Hand-arm bimanual intensive therapy and daily functioning of children with bilateral cerebral palsy: a randomized
Priscilla R P Figueiredo1, Marisa C Mancini2, Aline M Feitosa3
1Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Associação Mineira de Reabilitação, Belo Horizonte, Brazil.
Insights
Hand-Arm Bimanual Intensive Therapy (HABIT) significantly improved daily functioning in children with bilateral cerebral palsy (CP). However, bimanual performance did not show significant changes after the intervention.
Area of Science:
- Pediatric rehabilitation
- Neurology
- Occupational therapy
Background:
- Bilateral cerebral palsy (CP) affects daily functioning and hand dexterity in children.
- Current interventions often provide limited hours of therapy, potentially impacting outcomes.
Purpose of the Study:
- To evaluate the effectiveness of Hand-Arm Bimanual Intensive Therapy (HABIT) compared to customary care for children with bilateral CP.
- To assess changes in daily functioning, unimanual dexterity, and bimanual performance.
Main Methods:
- Forty-one children (4-16 years) with bilateral CP were randomized to HABIT (90 hours) or customary care (4.5 hours).
- Assessments included the Pediatric Evaluation of Disability Inventory (PEDI), Canadian Occupational Performance Measure (COPM), Jebsen-Taylor Test, Box and Blocks Test (BBT), and Both Hands Assessment.
- Data were analyzed using linear mixed-effects models.
Main Results:
- HABIT group showed significantly greater improvements in daily functioning (COPM performance and satisfaction, PEDI functional skills and caregiver assistance) compared to the customary care group.
- Significant improvements were observed in dominant hand dexterity (BBT) for the HABIT group.
- No significant changes were found in bimanual performance or non-dominant hand dexterity.
Conclusions:
- Hand-Arm Bimanual Intensive Therapy (HABIT) demonstrates potential benefits for improving daily functioning in children with bilateral CP.
- While HABIT enhances certain aspects of hand function and daily activities, its impact on overall bimanual performance requires further investigation.
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 : =9.50, p<0.01; COPMsatisfaction : =5.07, p<0.05; PEDIfunctional skills : =6.81, p<0.01; PEDIcaregiver assistance : =6.23, p<0.05) and in the dexterity of the dominant hand (BBT: =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.
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