Intensive bimanual training in children with hemiplegia improves bimanual coordination more than intensive unimanual training

Intensive bimanual training in children with hemiplegia improves bimanual coordination more than intensive unimanual training
1Family, Nutrition and Exercise Sciences, Queens College, CUNY, Flushing, NY:
2Biobehavioral Science, Teachers College, Columbia University, New York, NY, USA

Background/Objectives: To examine bimanual coordination during a functional bimanual drawer task for children with hemiplegic cerebral palsy (CP) before and after intensive unimanual and bimanual intervention, and to assess specificity of practice. To test three hypotheses: (i) children with hemiplegic CP will have better bimanual coordination during a functional drawer task after fifteen days of intensive intervention, (ii) children in the intensive bimanual intervention group will show more improvement than children in the unimanual intervention group. (iii) Both intensive interventions will improve the kinematic control of the involved hand.
Design: Exploratory cohort study
Participants and Setting: Twenty children with hemiplegic CP (age 4-12) participated in the study.
Materials/Methods: Children were randomly assigned to either intensive unimanual treatment (constraint-induced movement therapy: CIMT) or bimanual treatment (hand arm bimanual intensive therapy: HABIT). In both the CIMT and HABIT groups, children were engaged in play for 6 hours a day for 15 days (90 hours). To assess their improvement of bimanual control, children were asked to reach forward and open a spring-loaded drawer with one hand (drawer hand) and then activate a light switch inside the drawer with the contra lateral hand (task hand) before and after interventions. The role of the two hands was varied. 3D kinematic movement analyses were performed to identify the movement onset, offset, and the peak tangential velocity of each hand. Bimanual coordination was evaluated by goal synchronization (time differences between the two hands completing the task goal) and normalized movement overlap(the time when both hands were engaging in the task).
Results: Children with CP had significantly better bimanual coordination after the intensive treatment (goal synchronization P<0.001, movement overlap P=0.001). Additionally, greater improvement in bimanual coordination was found for children in the HABIT group (goal synchronization P=0.005, movement overlap P=0.047) and when the non-involved hand was used as the drawer hand (P<0.001). The peak velocity of the involved hand increased significantly after intervention when it was used to activate the switch (P=0.021).
Conclusions/Significance: Both intensive treatments (CIMT and HABIT) improve bimanual coordination for children with hemiplegic CP. Greater improvement was found for children in the intensive bimanual treatment (HABIT) group, supporting our hypothesis of practice specificity. Both treatments resulted in faster performance of the involved hand after intensive treatments.

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