Hand-Arm Bimanual Intensive Therapy And Daily Functioning Of Children With Bilateral Cerebral Palsy: A Randomized Controlled Trial

Aim To examine the efficacy of Hand-Arm Bimanual Intensive Therapy (HABIT) on daily functioning, unimanual dexterity, and bimanual performance of children with bilateral cerebral palsy (CP) compared with customary care. Method Forty-one children with bilateral CP, aged 4 to 16 years, classified in levels I to III of the Manual Ability Classification System, were randomly assigned to HABIT (90h) (n=21) or to customary care (4.5h) (n=20). Participants' daily functioning (Pediatric Evaluation of Disability Inventory [PEDI], Canadian Occupational Performance Measure [COPM]), unimanual dexterity (Jebsen-Taylor Test of Hand Function, Box and Blocks Test [BBT]), and bimanual performance (Both Hands Assessment) were assessed pre-, post-, and 6 months after the intervention. Linear mixed-effects models were used for inferential analysis. Results Children participating in HABIT showed greater improvements in daily functioning (COPMperformance:chi 12=9.50,p chi 12=5.07,p chi 12=6.81,p chi 12=6.23,p<0.05) and in the dexterity of the dominant hand (BBT:chi 12=3.99,p<0.05) compared with children maintaining customary care. Group or time effects did not explain any variance in bimanual performance or in the dexterity of the non-dominant hand. Interpretation HABIT may be beneficial for children with bilateral CP, with benefits evidenced for daily functioning outcomes.