Improvements in Kinematic Performance After Home-Based Bimanual Intensive Training for Children with Unilateral Cerebral Palsy

ABSTRACT

Aims: To evaluate the effects of home-based intensive bimanual training for children with unilateral spastic cerebral palsy (USCP) on bimanual coordination using 3-D kinematic analyses. Methods: Seven children with USCP (aged 29–54 months, MACS level: I-III) received 90 hours (2 hrs/day, 5days/week for 9 weeks) of Home Hand-Arm Bimanual Intensive Training (H-HABIT) provided by trained caregivers. A bimanual drawer-opening task was evaluated with eight infrared cameras using VICON workstation4.6 before and after training to assess improvements in bimanual coordination. Results: H-HABIT training significantly decreased the time between one hand opening the drawer and the other hand manipulating its contents (p < 0.05) and increased the percentage of time when both hands were moving simultaneously (p = 0.001), which are indicators of improved temporal bimanual coordination. In addition, participants demonstrated a 26% decrease in trunk displacement (p < 0.05), a 30% increase in upper arm joint excursion (p < 0.01), and a 25% increase in elbow extension (p < 0.05) for the affected side. All the improvements were maintained at 6-month posttest. Conclusions: H-HABIT improved not only temporal, but also quality of movement during a bimanual task for seven children with USCP. Thus, H-HABIT could be an alternative or adjunctive treatment for children with USCP.

KEYWORDS:

• Bimanual coordination
• cerebral palsy
• hemiplegia
• intensive bimanual training
• rehabilitation
• upper extremity

Acknowledgments

We sincerely thank the children and their families for participating in this study.

Declaration of Interest

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

Funding

This research was supported in part by a PSC-CUNY grant 69361‐47 to Ya-Ching Hung.

About the Authors

Ya-Ching Hung is a PT and a researcher in movement control for children with cerebral palsy.

Claudio Ferre is a researcher with great experience working on children with cerebral palsy.

Andrew Gordon has extensive experience providing various effective intensive training for children with cerebral palsy.