The Effect of Bimanual Training with or Without Constraint on Hand Functions in Children with Unilateral Cerebral Palsy: A Non-Randomized Clinical Trial

ABSTRACT

Aim: To compare the effect of bimanual training with or without constraint on manual functions in children with unilateral cerebral palsy (UCP). Methods: Seventeen children aged 6–11 years with UCP participated in one of two intensive therapeutic camps: bimanual (n = 9) incorporating one hour of constraint (“Hybrid”) or Bimanual (n = 8). Each camp met for 2 weeks, 5 days per week for 6 hours each day. The Assisting Hand Assessment (AHA) and the Jebsen Taylor Test of Hand Function (JTTHF) examined bimanual and unimanual functions pre, post- and 3-months post-intervention. Results: A significant improvement was noted in AHA scores for both groups between the pre-, post- and three months post-intervention [Hybrid (F2; 16 = 85.5, p < 0.01); Bimanual (F2; 16 = 15.4, p < 0.01)] with no significant differences between groups over time (F2; 30 = 0.74, p = 0.48). For the JTTHF, a significant improvement was noted in the affected hand following the Hybrid program (F2; 30 = 7.45, p = 0.01), while following the Bimanual program a significant difference was noted only in the less-affected hand (F2; 16 = 6.02, p < 0.01]. Conclusion: Both interventions Hybrid and Bimanual were similarly effective for improving use of the affected hand in bimanual tasks. The unique contribution of each intervention, the Hybrid program on the affected and the Bimanual on the less-affected side, warrants further examination.

KEYWORDS:

• Bimanual
• combined
• constraint
• motor learning
• unilateral cerebral palsy

Declaration of Interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Additional information

Notes on contributors

Marilyn Cohen-Holzer

Marilyn Cohen-Holzer is an Occupational Therapist.

Michal Katz-Leurer

Michal Katz-Leurer is a Physical Therapist.

Shirley Meyer

Shirley Meyer is an Orthopedist.

Dido Green

Dr. Dido Green and Dr. Shula Parush are Occupational Therapists.

Shula Parush

Dr. Dido Green and Dr. Shula Parush are Occupational Therapists.