Including a Lower-Extremity Component during Hand-Arm Bimanual Intensive Training does not Attenuate Improvements of the Upper Extremities: A Retrospective Study of Randomized Trials.

Geoffroy Saussez,Andrew M Gordon,Marina B Brandão,Yannick Bleyenheuft

doi:10.3389/fneur.2017.00495

Abstract

Hand-Arm Bimanual Intensive Therapy (HABIT) promotes hand function using intensive practice of bimanual functional and play tasks. This intervention has shown to be efficacious to improve upper-extremity (UE) function in children with unilateral spastic cerebral palsy (USCP). In addition to UE function deficits, lower-extremity (LE) function and UE–LE coordination are also impaired in children with USCP. Recently, a new intervention has been introduced in which the LE is simultaneously engaged during HABIT (Hand-Arm Bimanual Intensive Therapy Including Lower Extremities; HABIT-ILE). Positive effects of this therapy have been demonstrated for both the UE and LE function in children with USCP. However, it is unknown whether the addition of this constant LE component during a bimanual intensive therapy attenuates UE improvements observed in children with USCP. This retrospective study, based on multiple randomized protocols, aims to compare the UE function improvements in children with USCP after HABIT or HABIT-ILE. This study included 86 children with USCP who received 90 h of either HABIT (n = 42) or HABIT-ILE (n = 44) as participants in previous studies. Children were assessed before, after, and 4–6 months after intervention. Primary outcomes were the ABILHAND-Kids and the Assisting Hand Assessment. Secondary measures included the Jebsen-Taylor Test of Hand Function, the Pediatric Evaluation of Disability Inventory [(PEDI); only the self-care functional ability domain] and the Canadian Occupational Performance Measure (COPM). Data analysis was performed using two-way repeated-measures analysis of variance with repeated measures on test sessions. Both groups showed similar, significant improvements for all tests (test session effect p < 0.001; group × test session interaction p > 0.05) except the PEDI and COPM. Larger improvements on these tests were found for the HABIT-ILE group (test session effect p < 0.001; group × test session interaction p < 0.05). These larger improvements may be explained by the constant simultaneous UE–LE engagement observed during the HABIT-ILE intervention since many daily living activities included in the PEDI and the COPM goals involve the LE and, more specifically, UE–LE coordination. We conclude that UE improvements in children with USCP are not attenuated by simultaneous UE–LE engagement during intensive intervention. In addition, systematic LE engagement during bimanual intensive intervention (HABIT-ILE) leads to larger functional improvements in activities of daily living involving the LE.

Highlights

Cerebral palsy (CP) is the most common cause of pediatric motor disability with a prevalence ranging from 2 to 3.6 out of 1,000 children in western countries [1, 2]
We hypothesized that the introduction of a systematic lower extremity (LE) in addition to a bimanual intervention may lead to attenuated improvements in UE compared to regular HandArm Bimanual Intensive Therapy” (HABIT)
The results yielded similar UE motor improvements after both HABIT and HABIT-ILE for most assessments including our primary outcomes. While both groups showed significant improvements, larger improvements were observed for the PEDI and Canadian Occupational Performance Measure (COPM) performance measure for children of the HABIT-ILE group

Summary

Introduction

Cerebral palsy (CP) is the most common cause of pediatric motor disability with a prevalence ranging from 2 to 3.6 out of 1,000 children in western countries [1, 2]. The lesions are established from birth and are non-progressive, the motor impairments experienced by children with CP affect their autonomy and functional outcomes during their life-span. Motor symptoms such as impaired ability to walk may worsen during development [3]. One of the most disabling long-term functional deficits in children with unilateral spastic cerebral palsy (USCP) is impaired manual dexterity, i.e., impaired skilled hand movements and precision grip abilities [4]. It is well known that intensive interventions based on motor skill learning principles and goal-directed training are effective for improving UE function in children with USCP [5]. Focusing on improving bimanual coordination through structured play and functional activities during HABIT demonstrated efficacy to improve UE function in children with USCP [5]

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