Does Dosage Matter? A Pilot Study of Hand-Arm Bimanual Intensive Training (HABIT) Dose and Dosing Schedule in Children with Unilateral Cerebral Palsy

ABSTRACT

Aim: We compared the efficacy of hand-arm bimanual intensive training (HABIT) in two doses (90 vs. 45 hours) and two schedules of the same dose (90 vs. 2 × 45 hours) on hand and daily functioning. Method: Eighteen children with unilateral cerebral palsy were randomized to receive 6 hours of daily training over 3 weeks, totaling 90 hours (Group 90, n = 9) or receive 6 hours of daily training over 1.5 weeks, totaling 45 hours (Group 2 × 45, n = 9). After 6 months, Group 2 × 45 received an additional 45 hours. Hand (Jebsen–Taylor Test of Hand Function, Assisting Hand Assessment) and daily functioning tests (Canadian Occupational Performance Measure, Pediatric Evaluation of Disability Inventory) were administered before, immediately after, and 6 months after interventions. Results: Both groups demonstrated significant improvements in hand and daily functioning after 90 hours (Group 90) or the first 45 hours (Group 2 × 45), without differences between groups. However, more children from Group 90 obtained smallest detectable differences in the Assisting Hand Assessment. The addition of the second bout of 45 hours (Group 2 × 45) did not lead to further improvements. Conclusions: As this study was powered to test for large differences between groups, future investigations on larger samples will be needed to compare differences at the two dosage levels.

KEYWORDS:

• Bimanual training
• cerebral palsy
• dosage
• hand function
• intervention

Acknowledgment

We thank all participants, their families, the volunteered interventionists and the Associação Mineira de Reabilitação (AMR).

Declaration of interest

The authors report no declarations of interest.

About the Authors

Marina B. Brandao, is Adjunct Professor at the Graduate Program in Rehabilitation Sciences and at the Department of Occupational Therapy, Universidade Federal de Minas Gerais (UFMG), Brazil. Marisa C. Mancini, is full professor at the Graduate Program in Rehabilitation Sciences and at the Department of Occupational Therapy, Universidade Federal de Minas Gerais (UFMG), Brazil. Claudio L. Ferre, is Postdoctoral Research Fellow at Clinical Laboratory for Early Brain Injury Recovery at Burke-Cornell Medical Research Institute, USA. Priscilla R.P. Figueiredo, is Research Coordinator at Núcleo de Ensino e Pesquisa, Associação Mineira de Reabilitação (AMR), Brazil. Rachel H.S. Oliveira, was a master's degree student at Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Brazil. Shirley C. Gonçalves and Miriam C.S. Dias, are clinical occupational therapists, Brazil. Andrew M. Gordon, is Professor of Movement Science and Neuroscience and Education, Department of Biobehavioral Sciences, Teachers College, Columbia University, USA.

Additional information

Funding

This study was supported by Fundação de Amparo em Pesquisa de Minas Gerais (FAPEMIG) and Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil.