Commentary on "Intensive Bimanual Intervention for Children Who Have Undergone Hemispherectomy: A Pilot Study".

Abstract

“How should I apply this information?” Sensorimotor deficits that result from hemispherectomy are more severe and debilitating than other forms of hemiplegia. For families with a child who requires this surgical approach and the clinicians who support them during their postoperative rehabilitation, little information is available regarding motor changes in response to specific interventions. This preliminary work offers hope. Regardless of the subject's interhemispheric lateralization, type of hemiplegia, or length of time from surgery, clinically meaningful changes in bimanual function were reported with Hand-Arm Bimanual Intensive Training (HABIT). Given this approach received a “green-light” rating by Novak et al1 in a 2019 systematic review and it is grounded in key principles associated with experience-dependent neuroplasticity, this finding is not surprising. These key principles are focused on: task-specific practice, goal-directed tasks and activities, high-intensity doses of meaningful practice, and self-generated, active movement. From a family's perspective, HABIT represents an escape from “appointment fatigue” and an opportunity to intensively practice real-life activities. “Our daughter became more aware and intentional about using her affected side, and ... activities carried over to home!” “What should I be mindful of when applying this information?” Ninety hours of intervention within a 2-week period requires a high level of commitment from families, children, clinicians, health care organizations that employ clinicians, and third-party payers. Cost-effectiveness analysis is not considered nor are sustainable funding mechanisms discussed. For therapists providing intervention in school-based settings, this intensity of service and the one-on-one support it requires is not feasible; for those in outpatient settings, the time required for organizing and implementing HABIT, the materials needed to engage children across a broad range of ages for 6 hours of daily therapy, and the limited reimbursement options for therapists' one-on-one involvement require a high level of creativity and pose unique challenges. Future research should explore family perspectives, cost-effectiveness, and dose-response parameters that might further individualize the length of necessary intervention. Sandra L. Willett, PT, PhD, PCS Emily Drew, PT, PCS Munroe-Meyer Institute, University of Nebraska Medical Center, Omaha, Nebraska Jennifer Dibbern Parent, Omaha, Nebraska