Intensive Unimanual Training Leads to Better Reaching and Head Control than Bimanual Training in Children with Unilateral Cerebral Palsy

Abstract

Aims

To quantify the changes in joint movement control and motor planning of the more-affected upper extremity (UE) during a reach-grasp-eat task in children with Unilateral Spastic Cerebral Palsy (USCP) after either constraint-induced movement therapy (CIMT) or hand-arm bimanual intensive therapy (HABIT).

Methods

Twenty children with USCP (average age 7.7; MACS levels I-II) were randomized into either a CIMT or HABIT group. Both groups received intensive training 6 h a day for 15 days. Children performed a reach-grasp-eat task before and after training with their more-affected hand using 3D kinematic analysis.

Results

Both groups illustrated shorter movement time during reaching, grasping, and eating phases after training (p < 0.05). Additionally, both intensive training approaches improved joint control with decreased trunk involvement, greater elbow, and wrist excursions during the reaching phase, and greater elbow excursion during the eating phase (p < 0.05). However, only the CIMT group decreased hand curvature during reaching, lowered hand position at grasp, and decreased head rotation during the eating phase (p < 0.05).

Conclusions

The current findings showed that both CIMT and HABIT improved UE joint control, but there were greater effects of CIMT on the more-affected UE motor planning and head control for children with USCP.

Keywords:

• Cerebral palsy
• hemiplegia
• kinematics
• pediatric
• rehabilitation
• upper extremity

Acknowledgments

We thank the children and their families for participating in this study. We also thank the volunteer interventionists, and all the supervisors for the treatments.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The work was supported by grants from the Thrasher Research Fund and NIH R01 HD 076436-01A1.

Notes on contributors

Ya-Ching Hung

Dr. Ya-Ching Hung received her B.A. in Physical Therapy at National Taiwan University, an M.S. and Ed.M. in Motor Learning and Control at Teachers College, Columbia University, and a Ed.D. in Motor Learning and Control from Teachers College, Columbia University. Her research focuses on evaluating bimanual coordination and whole body posture and gait movement control and learning for children with and without movement impairments using three-dimensional kinematic analysis.

Aryeh Spingarn

Mr. Aryeh Spingarn received his B.A. in Nutrition and Exercise Sciences a Queens College, CUNY, and a M.S. in Exercise Physiology at Queens College, CUNY. His research focuses on movement analysis for children.

Kathleen M. Friel

Dr. Kathleen M. Friel received her B.A. in Biology at Rice University, an M.S. in Neuroscience at the University of Texas Health Sciences Center at Houston, and a Ph.D. in Neurophysiology from the University of Kansas Medical Center. She completed a postdoctoral fellowship at Columbia University Medical Center. She also received a M.S. in Biostatistics from Columbia University, with a focus on patient-oriented research. Her research focuses on the importance of motor activity in neurorehabilitation.

Andrew M. Gordon

Dr. Andrew M. Gordon received his B.A. in Cognitive Science/Physiology at Hampshire College, an M.S. in Kinesiology at the Pennsylvania State University, and a Ph.D. in Motor control and Development from the Karolinska Institute. He completed a postdoctoral fellowship at University of Minnesota. His research focuses on motor learning and development in typically developing children and children with cerebral palsy. His team has been studying hand motor control in healthy individuals and individuals with cerebral palsy (CP) for over 25 years.