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Mirror movements after bimanual intensive therapy in children with unilateral cerebral palsy: A randomized controlled
Rodrigo Araneda1,2, Enimie Herman1, Louis Delcour1
1Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium.
Insights
Hand and Arm Bimanual Intensive Therapy Including Lower Extremity (HABIT-ILE) training significantly reduced mirror movements in children with cerebral palsy (CP). These improvements in motor control were sustained at 3-month follow-up and linked to better daily living activities.
Area of Science:
- Neurology
- Rehabilitation Medicine
- Pediatric Physical Therapy
Background:
- Unilateral cerebral palsy (CP) often involves motor impairments, including mirror movements, which are involuntary movements in the unaffected limb mirroring voluntary movements in the affected limb.
- Mirror movements can hinder functional recovery and bimanual coordination in children with CP.
Purpose of the Study:
- To evaluate the efficacy of Hand and Arm Bimanual Intensive Therapy Including Lower Extremity (HABIT-ILE) in reducing mirror movements in children with unilateral CP.
- To assess the long-term effects of HABIT-ILE on mirror movements and their association with functional outcomes.
Main Methods:
- A randomized controlled trial involving 31 children with unilateral CP.
- Participants were assigned to either a treatment group receiving 90 hours of HABIT-ILE or a control group receiving customary care.
- Mirror movements were assessed using the Woods and Teuber Scale, alongside other functional measures, at baseline, post-intervention, and at a 3-month follow-up.
Main Results:
- HABIT-ILE significantly decreased mirror movements in both the more-affected and less-affected hands (p < 0.001).
- These improvements were maintained at the 3-month follow-up assessment.
- Reduced mirror movements were inversely correlated with improvements in activities of daily living, particularly in the less-affected hand.
Conclusions:
- HABIT-ILE is an effective intervention for reducing mirror movements in children with unilateral CP.
- The therapy leads to sustained improvements in motor control and is associated with enhanced bimanual performance and daily living activities.
Aim:
To investigate potential changes in mirror movements after Hand and Arm Bimanual Intensive Therapy Including Lower Extremity (HABIT-ILE) training in children with unilateral cerebral palsy (CP).
Method:
Thirty-one children with unilateral CP (mean age 9 years 4 months, SD 4 years 3 months; range 5 years 4 months-17 years 3 months; 14 females, 17 males) were randomized to either a control or treatment group. After allocation, children were assessed three times: before (T1, baseline) and after (T2) a 2-week interval and again at 3 months after T1 (T3) as follow-up. Between T1 and T2, the treatment group received 90 hours of HABIT-ILE training, while the control group continued their customary treatment. Mirror movements were assessed in all children using the Woods and Teuber Scale, as well as the Assisting Hand Assessment, Pediatric Evaluation of Disability Inventory, and Canadian Occupational Performance Measure.
Results:
Repeated measures analysis of variance indicated a significant decrease in mirror movements in the more-affected (mean difference = 0.97; 95% confidence interval [CI] = 0.51-1.42; p < 0.001) and less-affected (mean difference = 0.71; 95% CI = 0.37-1.0; p < 0.001) hands of children after HABIT-ILE; these improvements were maintained at the 3-month follow-up. Moreover, the mirror movement changes observed at the second assessment (T2) were inversely correlated with changes in the assessment of activities of daily living, especially in the less-affected hand.
Interpretation:
HABIT-ILE decreased the intensity of mirror movements in a group of children with CP. Furthermore, mirror movement changes were associated with bimanual performance and activities of daily living in these children.
What This Paper Adds:
The intensity of mirror movements decreased in both hands after 2 weeks of Hand and Arm Bimanual Intensive Therapy Including Lower Extremity (HABIT-ILE) training. Mirror movement changes were maintained at the 3-month follow-up after HABIT-ILE. Mirror movement changes were associated with improvements in bimanual performance and activities of daily living.
