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Early Intensive Bimanual Stimulation Program (BB-Bim) for Infants at Risk of Unilateral Cerebral Palsy: A Randomized,
Rachel Bard-Pondarré1, Carole Vuillerot2, Nahime Al-Abiad3
1Rachel Bard-Pondarré, OT, MSc, is Occupational Therapist and Research Project Coordinator, Centre des Massues Croix-Rouge française, Lyon, France; bard.rachel@orange.fr.
Insights
This study shows that a home-based bimanual stimulation program is feasible for infants at high risk of cerebral palsy (CP). The intervention improved bimanual hand function in these infants.
Area of Science:
- Pediatrics
- Neurology
- Rehabilitation Medicine
Background:
- Clinical guidelines emphasize early, intensive intervention for infants at high risk of cerebral palsy (CP).
- Home-based programs offer a potential solution for delivering early intervention to infants with CP.
Purpose of the Study:
- To assess the feasibility of a novel, home-based, early intensive bimanual stimulation program (BB-Bim).
- To evaluate the impact of the BB-Bim program on hand function in infants at risk of unilateral CP.
Main Methods:
- A single-case experimental design with a multiple baseline across subjects was employed.
- The study included infants aged 3-12 months with suspected unilateral CP.
- Intervention involved parent-provided bimanual stimulation (20 min/day, 6x/wk) with weekly occupational therapist coaching.
Main Results:
- Six infants participated; parents reported high feasibility and relevance of the BB-Bim program.
- The program significantly improved bimanual and total hand function scores (Hand Assessment in Infants - HAI).
- Goal Attainment Scaling (GAS) scores showed improvement with the intervention for most participants.
Conclusions:
- The home-based bimanual stimulation program (BB-Bim) is feasible for infants at risk of unilateral CP.
- Parent-delivered bimanual stimulation, supported by occupational therapist coaching, can improve bimanual hand function.
- This approach shows promise for enhancing functional hand interactions in infants with or at risk for CP.
Importance:
Clinical practice guidelines for infants at high risk of cerebral palsy (CP) emphasize the importance of very early and intensive intervention.
Objective:
To determine the feasibility of a new, home-based, early intensive bimanual stimulation program (BB-Bim) and its impact on hand function in infants at risk of unilateral CP.
Design:
Single case experimental design, multiple baseline across subjects, lasting from 12 to 15 wk, including a 4- to 7-wk randomized baseline, followed by 8 wk of BB-Bim.
Setting:
Home.
Participants:
Infants (ages 3-12 mo) with suspected unilateral CP, whose parents agreed to participate in the stimulation program.
Intervention:
Parent-provided bimanual stimulation 20 min/day, 6×/wk, with weekly occupational therapist coaching visits.
Measures:
Weekly repeated measures were the Hand Assessment in Infants (HAI) and Goal Attainment Scaling (GAS). Feasibility and relevance were assessed with a logbook and a parental report, including 10 continuous 0-10 scaled questions.
Results:
Six infants were included (2 with left and 4 with right brain lesions). Parents provided a mean 3.4 to 6.2 stimulation sessions/wk. Feasibility and relevance were highly rated (Ms = 8.2-9.6, SDs = 0.2-1.3). Stimulation significantly improved HAI bimanual and total scores for all infants, with no impact on HAI unilateral scores. GAS scores improved with stimulation (significant for 3 infants).
Conclusions And Relevance:
BB-Bim was feasible and tended to improve bimanual function in infants at risk of unilateral CP. What This Article Adds: Parent-provided daily bimanual stimulation at home is feasible when parents are coached weekly by an occupational therapist. Bimanual stimulation seems to improve functional interactions between the hands among infants at high risk of unilateral CP.
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