Bimanual Intensive Training Research Articles

Effectiveness of intensive motor learning approaches from working on a vertical surface on hemiplegic children’s upper limb motor skills, a randomized controlled trial

Purpose This study compares the effect of intensive motor learning approaches on improving the quality of upper extremity skills in children with unilateral cerebral palsy (UCP) by working on vertical surfaces versus horizontal surfaces during rehabilitation sessions. Materials and methods Forty UCP children of both sexes were randomized into two equal groups. All participants received 60 min of intensive motor learning approaches three days/week for three successive months. These approaches included constraint-induced movement therapy (CIMT), in which children wore a splint or sling on the unaffected upper limb, as well as hand-arm bimanual intensive training (HABIT) that requires the use of both hands during specific play-based activities. The control group received training on a horizontal surface while the child sat in front of an elbow-height table while the study group (vertical surface training) sat or stood in front of a wall/mirror/board. The task requirements were graded to ensure success. Results Statistically significant differences were detected between the mean values of post-treatment of all scorers, with a greater percentage of improvement in favor of the study group. Conclusions This study revealed that working on a vertical surface improved upper limb motor skills more significantly than working on a horizontal surface.

HABIT training in unilateral spastic cerebral palsy children having mirror movement disorder.

The single-arm feasibility study was planned to evaluate the therapeutic effect of hand arm bimanual intensive training in improving the fine and gross motor functions of hand, and in the reduction of intensity with respect to mirror movement disorder. The sample comprised unilateral spastic cerebral palsy children aged 6-16 years who were having mirror movement disorder and were able to make a gross grip. The hand arm bimanual intensive training was provided to the participants for 6 hours per day for 15 days for a total of 90 hours. Comparison of baseline and post-intervention showed that the functional independence level of children had improved, with improvement in unimanual and bimanual hand performance (p˂0.05). However, there was no improvement seen in the severity of mirror movements (p>0.05). Hence, hand arm bimanual intensive training was found to be effective in increasing the functional independence of cerebral palsy children by improving the hand function, but there was no effect on mirror movement disorder.

Pairing transcutaneous vagus nerve stimulation with an intensive bimanual training in children and adolescents with cerebral palsy: study protocol of a randomized sham-controlled trial.

Gross motor function impairments and manual dexterity deficits are frequently observed in children and adolescents with Cerebral Palsy (CP), having a major impact on their activity level and autonomy. Improving manual dexterity and activity level of patients with CP is often the focus of rehabilitation. Novel and adjuvant treatment methods that could support the standard training also in chronic conditions are a research priority. The transcutaneous Vagus Nerve Stimulation (tVNS) is a non-invasive brain stimulation technique, which provides a bottom-up stimulation of subcortical and cortical brain structures, enhancing brain GABA and Noradrenaline levels. This technique may play a pivotal role in brain plasticity, which has not been tested in CP patients before. 44 children and adolescents with CP will be involved, treated in pairs in a randomized, double-blind, pre-post test study. The two groups will undergo the Hand-Arm Bimanual Intensive Therapy Including Lower Extremities (HABIT-ILE) for 2 consecutive weeks, with 3 h daily sessions for 5 days per week, for an overall time interval of 30 h; the training will be combined with the application for 75 min/day of active or sham tVNS, in separate, randomly allocated groups. The primary outcome measure will include the scores at the Assisting Hand Assessment and Box and Block Test, and at an ad-hoc visuomotor task evaluating manual visuomotor control. Secondary outcomes will include the scores at the Children's Hand Experience Questionnaire, Canadian Occupational Performance Measure, Melbourne Assessment of Unilateral Upper Limb Function, Gross Motor Function Measure, Vineland, Pediatric quality of life inventory. The evaluation points will include pre (T0), post (T1) and 3-month follow up (T2) assessments. Safety and tolerability will also be assessed. The results of this trial will assess whether tVNS can effectively boost the effects of an intensive two-week bimanual training, in improving manual dexterity in children and adolescents with cerebral palsy, ensuring safety and tolerability throughout the intervention period.Clinical trial registration: ClinicalTrials.gov, NCT06372028.

Effectiveness of routine physical therapy with or without home-based intensive bimanual training on clinical outcomes in cerebral palsy children: a randomised controlled trial

IntroductionThis study aimed to test how normal physical treatment, with or without home-based intense bimanual training, affected hand coordination and daily living activities in children with cerebral palsy.MethodsA randomised controlled experiment was carried out at DHQ Hospital in Kasur, Pakistan. Thirty children with unilateral spastic cerebral palsy took part in the study. The first group received standard physical treatment, whereas the second group received bimanual training along with routine physical therapy. Follow-ups were performed in the fourth and sixth weeks. The paediatric motor log activity scale and the ABILHAND questionnaire were used to assess daily activities and coordination, respectively.ResultsAt baseline, no significant association was seen between treatment groups and hand coordination outcome among the patients (p = 0.0450) and no significant difference was seen in patients in both treatment groups regarding their activities of daily living. In group A, no significant improvement was seen in hand coordination from baseline until the 6th week (p = 0.257) while in group B, a significant difference was seen in hand coordination from baseline until the 6th week follow-up (p = 0.000).ConclusionsThis study concluded that the combined effect of home-based bimanual exercises and routine physical therapy shows significant achievements in hand coordination and activities of daily living.

The Effect of Bimanual Intensive Functional Training on Somatosensory Hand Function in Children with Unilateral Spastic Cerebral Palsy: An Observational Study.

(1) Background: Next to motor impairments, children with unilateral spastic cerebral palsy (CP) often experience sensory impairments. Intensive bimanual training is well known for improving motor abilities, though its effect on sensory impairments is less known. (2) Objective: To investigate whether bimanual intensive functional therapy without using enriched sensory materials improves somatosensory hand function. (3) Methods: A total of twenty-four participants with CP (12-17 years of age) received 80-90 h of intensive functional training aimed at improving bimanual performance in daily life. Somatosensory hand function was measured before training, directly after training, and at six months follow-up. Outcome measures were: proprioception, measured by thumb and wrist position tasks and thumb localization tasks; vibration sensation; tactile perception; and stereognosis. (4) Results: Next to improving on their individual treatment goals, after training, participants also showed significant improvements in the perception of thumb and wrist position, vibration sensation, tactile perception, and stereognosis of the more affected hand. Improvements were retained at six months follow-up. Conversely, proprioception measured by the thumb localization tasks did not improve after training. (5) Conclusions: Intensive functional bimanual training without environmental tactile enrichment may improve the somatosensory function of the more affected hand in children with unilateral spastic CP.

Commentary on “Hand-Arm Bimanual Intensive Training in Virtual Reality: A Feasibility Study”

Commentary on “Hand-Arm Bimanual Intensive Training in Virtual Reality: A Feasibility Study”

Hand-Arm Bimanual Intensive Training in Virtual Reality: A Feasibility Study.

The aim of the study was to evaluate the feasibility of virtual reality (VR) software built using the core concepts of hand-arm bimanual intensive training (HABIT) for improving upper extremity motor function in children with cerebral palsy (CP). Eight children with CP participated in a 10-day, 40-hour HABIT program. Half of the time custom VR software, HABIT-VR was used. The children's motor skills were assessed pre- and postintervention with the Assisting Hand Assessment, Box and Blocks Test, and Nine-Hole Peg Test. The children had significant and clinically relevant changes in the Assisting Hand Assessment and Box and Blocks Test; however, Nine-Hole Peg Test scores did not change with intervention. These data suggest that combining traditional HABIT strategies with HABIT-VR games improve upper extremity function and gross motor skills but not fine motor skills.

Effects of Hand-Arm Bimanual Intensive Training on Fine Motor Skills in Patients of Chronic

Aim: To determine the effects of Hand-arm Bimanual Intensive Training on fine motor skills of chronic stroke patients. Methods: A randomized control trail was conducted at District Head Quarter Hospital Sargodha. Twenty-eight stroke patients were randomized into 2 groups. All patients were examined by using Questionnaire of Disabilities of Arm, Shoulder, and Hand (DASH), Action Research Arm Test (ARAT) and Wolf Motor Function Test (WMFT). Control group was treated with Conventional Physical Therapy and experimental group with Hand Arm Bimanual Intensive Training. There were 3 sessions every week for a total of 12 sessions over the course of 4 weeks. At the beginning of the intervention, two weeks later, and four weeks later, all outcomes were evaluated. Data analysis was done with SPSS version 21. Results: Intra group analysis showed statistically significant results (p<0.001) in each group after 4 weeks of treatment indicating improvement in Disabilities of Arm, Shoulder, and Hand (DASH), Action Research Arm Test (ARAT) and Wolf Motor Function Test (WMFT) of both groups. However, based on their mean differences, experimental group demonstrated greater progress across all outcome measures which is indicated through Inter group analysis that statistically significant difference was present between two groups in DASH, ARAT and WMFT with p-values 0.045, 0.046 and 0.043 respectively at end of treatment. Practical implications: HABIT pays attention to bimanual training which is highly related to most ADL tasks so there is need to evaluate the effectiveness of HABIT-related interventions. This will help to promote improvements in upper extremity functions and to enhance the level of independence among stroke patients. Conclusion: Study concluded that both conventional physical therapy and hand arm bimanual intensive training (HABIT) are helpful in improving upper extremity fine motor abilities in chronic stroke patients, but HABIT is more beneficial as compared to usual conventional and routine rehab treatments. Keywords: HABIT, fine motor skills, physical therapy, upper extremity, stroke.

Upper limb manual training for children with cerebral palsy: A systematic review and network meta-analysis of randomized controlled trials

Objective There are different upper limb manual training protocols, namely constraint-induced movement therapy, modified constraint-induced movement therapy, hand–arm bimanual intensive training, hand–arm bimanual intensive training including lower extremity, action observation training, and mirror therapy, available for improving functional outcomes in children with cerebral palsy. However, the effect and priority of these strategies remain unclear. Data sources We searched the PubMed, Cochrane Library, and Embase databases for relevant articles from inception to October 12, 2022. Review methods To assess the effect and priority of different strategies of upper limb manual training protocols through a systematic review and network meta-analysis of randomized controlled trials. Results We included 22 randomized controlled trials in this network meta-analysis. The ranking probability and standard mean differences with 95% credible intervals of the comparison between placebo and other forms of upper limb manual training were as follows: mirror therapy = 2.83 (1.78, 3.88), hand–arm bimanual intensive training including the lower extremity = 0.53 (0.09, 0.96), constraint-induced movement therapy = 0.44 (0.18, 0.71), hand–arm bimanual intensive training = 0.41 (0.15, 0.67), modified constraint-induced movement therapy = 0.39 (0.03, 0.74), and action observation training = 0.18 ( − 0.29, 0.65). No significant inconsistency was noted between the results of direct and indirect comparisons. Conclusion We suggest that mirror therapy could be the upper limb manual training protocol of choice for improving functional outcomes in patients with cerebral palsy.

Comparison of Constrained Induced Movement Therapy and Bimanual Training on Functional Outcome of Hemiplegic Cerebral Palsy

OBJECTIVES The aim of this study was to compare the effects of constrained induced movement therapy (CIMT) and BimanualIntensive Training (BIT) on functional outcomes of hemiplegic cerebral palsy children. METHODOLOGY Cerebral palsy children with age groups of 5 to 12 years were included with a total sample size of 38. Simplerandom sampling was done, and data was collected from Islamabad. Two groups were formed and named groupA: constrained induced movement therapy with 19% and group B: bimanual training with 19% respectively. Thefunctional outcome for the CIMPT and for the BIT group was assessed on the pretest and post-test scoreevaluation of QUEST and JTHF tests. RESULTS Statistically significant (p <0.05) improvement was found in The Quality of Upper Extremity Skills Test (QUEST)and Jebsen-Taylor Test of Hand Function (JTHF) in the between -group analysis. For within the group analysisthe p-value <0.05 suggests that there was a significant diffe rence in within-group analysis too. The values forgrasp and dissociated movements suggest that QUEST post-test values are impactful in the CMIT group whereasin the BIT group simultaneous and spontaneous movement was increased but JTHF post -test values were moresignificant in CMIT. CONCLUSION BIT is more beneficial for both hand’s simultaneous and spontaneous movement, whereas CMIT is morebeneficial for grip and overcoming the “learned-nonuse” phenomena in cerebral palsy children.

Effect of hand arm bimanual intensive therapy (HABIT) on gross motor functions in upper extremity of spastic CP

To review studies that can examine whether there’s effect of hand arm bimanual intensive training(HABIT) and neurodevelopmental treatment on gross motor function in spastic cerebral palsy. Journal articles published between 2011 and 2021 were secured by searching computerized bibliographical databases. High evidence studies as randomized control trials, systematic reviews and cross sectional studies were included. A total of 30 studies were selected. After analyzing the studies, it was seen that; there is effect of HABIT in upper extremity on gross motor function, functional training , manual dexterity and activities of daily living and NDT was also improved gross motor function, spasticity and strength in upper extremity.

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

“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

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

To conduct a pilot study to assess the feasibility and effectiveness of an intensive bimanual intervention on upper limb function in children who have undergone hemispherectomy. Thirteen children received 90 hours of intensive bimanual training (Hand-Arm Bimanual Intensive Therapy, HABIT). The Jebsen-Taylor Test of Hand Function (JTTHF), Box and Block Test (BBT), Assisting Hand Assessment (AHA), ABILHAND-Kids, and Canadian Occupational Performance Measure (COPM) were assessed by a masked clinician twice before, immediately, and 6 months after treatment. Significant improvements over time were found in the JTTHF, AHA, ABILHAND-Kids, and COPM. Completion of HABIT was feasible for children with hemispherectomy. Improvement of bimanual function and functional goals can be related to the nature of the activities prioritized in HABIT training.

Preschool HABIT-ILE: study protocol for a randomised controlled trial to determine efficacy of intensive rehabilitation compared with usual care to improve motor skills of children, aged 2–5 years, with bilateral cerebral palsy

IntroductionYoung children with bilateral cerebral palsy (BCP) often experience difficulties with gross motor function, manual ability and posture, impacting developing independence in daily life activities, participation and quality of life....

Effectiveness of hand-arm bimanual intensive training on upper extremity function in children with cerebral palsy: A systematic review.

To systematically review the effectiveness of Hand-Arm Bimanual Intensive Training (HABIT) on upper limb function in children with cerebral palsy. Six databases (MEDLINE, CINAHL, PubMed, Embase, Cochrane Library, and PsycINFO) were searched for HABIT-related studies published in English between 2007 and 2017. The methodological quality of the included studies was classified based on the Levels of Evidence of the American Occupational Therapy Association guidelines. If the included studies were randomized controlled trials (RCTs), the methodological quality was evaluated using the Revised Cochrane risk of bias tool. Cohen's d effect sizes were computed and synthesized to assess the effectiveness. Among 646 studies, 15 fulfilled the inclusion criteria. Eleven studies were RCTs, 64% of which were rated as having a high risk of bias; one was a quasi-RCT, one was a retrospective study, and two were longitudinal studies. Nearly half of the included studies used HABIT for 6h a day for three consecutive weeks (totaling 90h), and some studies used different doses/schedules or added training components to HABIT. Synthesis of the results demonstrated a significantly small effect size (d=0.36, P=0.017) for improving upper limb function immediately after the interventions, and the improvements were maintained at follow-up. Similarly, significantly moderate or large effect sizes were found for self-care function (d=0.52, P=0.003) and goal improvements (d=1.78-2.28, P<0.001). This review supports the effectiveness of HABIT as an intervention for improving upper limb function in children with cerebral palsy.

The effects of modified constraint-induced movement therapy combined with intensive bimanual training in children with brachial plexus birth injury: a retrospective data base study

Background In children with Brachial Plexus Birth Injury, a non-use of the affected upper limb despite sufficient capacity, is sometimes observed, called developmental disregard. The combination of modified constraint-induced-movement-therapy with bimanual training is frequently applied to overcome developmental disregard in unilateral Cerebral Palsy. In the current study the effects of the combination of modified constraint-induced-movement-therapy with bimanual training are investigated in children with Brachial Plexus Birth Injury in comparison to children with unilateral Cerebral Palsy. We hypothesize that the combination of modified constraint-induced-movement-therapy with bimanual training is effective in Brachial Plexus Birth Injury. Methods Data of 19 children with Brachial Plexus Birth Injury (M age: 4.1 years) and 18 with unilateral Cerebral Palsy (M age: 4.5 years) were compared. The effects of modified constraint-induced-movement-therapy with bimanual training (54 h modified constraint-induced-movement-therapy, 18 h bimanual training, 8–10 weeks) was investigated by assessing spontaneous affected-upper-limb-use (“Assisting Hand Assessment”), manual abilities (“ABILHAND-kids”) and subjective performance and satisfaction of problematic bimanual activities (“Canadian Occupational Performance Measure”) at three time points (pre-treatment, post-treatment, follow-up). This data was analyzed using repeated-measures analysis. Results Children with Brachial Plexus Birth Injury showed significant improvements on all outcome measures following modified constraint-induced-movement-therapy with bimanual training. These results were comparable to those observed in the group of children with unilateral Cerebral Palsy. Discussion These results suggest that modified constraint-induced-movement-therapy with bimanual training is effective in Brachial Plexus Birth Injury. They indicate a comparable improved bimanual performance in children with Brachial Plexus Birth Injury than in unilateral Cerebral Palsy and suggests that both groups of children have affectively overcome their developmental disregard. IMPLICATIONS FOR REHABILITATION Children with Brachial Plexus Birth Injury frequently experience difficulties in activities of daily living. It has recently been suggested that children with Brachial Plexus Birth Injury may also show a non-use of the affected upper limb despite sufficient capacity, called developmental disregard. Children with Brachial Plexus Birth Injury and developmental disregard might therefore benefit from intensive therapies aimed at overcoming developmental disregard, originally developed for children with unilateral Cerebral Palsy. A combination of modified Constrained-Induced Movement Therapy with intensive Bimanual Training has shown to be affective in children with unilateral Cerebral Palsy. In a small sample, this study shows that a combination of modified Constrained-Induced Movement Therapy with intensive bimanual training is effective in children with Brachial Plexus Birth Injury, comparable and even more than in unilateral Cerebral Palsy.

Protocol for a multisite randomised trial of Hand–Arm Bimanual Intensive Training Including Lower Extremity training for children with bilateral cerebral palsy: HABIT-ILE Australia

IntroductionChildren with bilateral cerebral palsy often experience difficulties with posture, gross motor function and manual ability, impacting independence in daily life activities, participation and quality of life (QOL). Hand–Arm Bimanual...

Adopting Text Mining on Rehabilitation Therapy Repositioning for Stroke.

Stroke is a common disabling disease that severely affects the daily life of patients. Accumulating evidence indicates that rehabilitation therapy can improve movement function. However, no clear guidelines have specific and effective rehabilitation therapy schemes, and the development of new rehabilitation techniques has been relatively slow. This study used a text mining approach, the ABC model, to identify an existing rehabilitation candidate therapy method that is most likely to be repositioned for stroke. In the model, we built the internal links of stroke (A), assessment scales (B), and rehabilitation therapies (C) in PubMed and the links were related to upper limb function measurements for patients with stroke. In the first step, using E-utility, we retrieved both stroke-related assessment scales and rehabilitation therapy records and then compiled two datasets, which were called Stroke_Scales and Stroke_Therapies, respectively. In the next step, we crawled all rehabilitation therapies co-occurring with the Stroke_Therapies and then named them as All_Therapies. Therapies that were already included in Stroke_Therapies were deleted from All_Therapies; therefore, the remaining therapies were the potential rehabilitation therapies, which could be repositioned for stroke after subsequent filtration by a manual check. We identified the top-ranked repositioning rehabilitation therapy and subsequently examined its clinical validation. Hand-arm bimanual intensive training (HABIT) was ranked the first in our repositioning rehabilitation therapies and had the most interaction links with Stroke_Scales. HABIT significantly improved clinical scores on assessment scales [Fugl-Meyer Assessment (FMA) and action research arm test (ARAT)] in the clinical validation study for acute stroke patients with upper limb dysfunction. Therefore, based on the ABC model and clinical validation, HABIT is a promising repositioned rehabilitation therapy for stroke, and the ABC model is an effective text mining approach for rehabilitation therapy repositioning. The findings in this study would be helpful in clinical knowledge discovery.

Changes in Tactile Function During Intensive Bimanual Training in Children With Unilateral Spastic Cerebral Palsy.

Recently, an intensive bimanual intervention using sensory enriched materials resulted in improved tactile function in children with unilateral spastic cerebral palsy (USCP), raising the question of whether the observed tactile function improvement was due to the sensory enriched environment or the bimanual intervention per se. The present study investigates whether a bimanual intensive intervention improves tactile function. Nineteen children with USCP received 90 hours of bimanual training without enriched environment. Primary outcomes: Manual Form Perception Test/MFPT, Grating Orientation Task/GOT. Children were assessed before, after the training, and at the 4-month follow-up. Significant improvements were observed in MFPT for the more affected hand ( P = .015). Larger stereognosis/MFPT improvements correlated with poorer baseline motor function. Intensive bimanual training alone was sufficient to improve stereognosis, though no improvement in GOT was observed. Present and previously published findings suggest that environmental tactile enrichment incorporated into a bimanual motor training may be needed to improve spatial discrimination/GOT in children with USCP.

Short-term Efficacy of Hand-Arm Bimanual Intensive Training on Upper Arm Function in Acute Stroke Patients: A Randomized Controlled Trial.

Rehabilitation training during the acute phase of stroke (<48 h) markedly improves impaired upper-limb movement. Hand-arm bimanual intensive training (HABIT) represents an intervention that promotes improvements in upper extremity function in children with cerebral palsy. This study repurposed HABIT in acute stroke patients and assessed recovery of upper extremity function when compared with a conventional rehabilitation program (CRP). In a randomized trial, 128 patients with acute stroke were assigned to the HABIT or the CRP groups. The primary endpoint was clinical motor functional assessment that was guided by the Fugl-Meyer motor assessment (FMA) and outcomes of the action research arm test (ARAT). The secondary endpoint was an improved neurophysiological evaluation according to the motor-evoked potential amplitude (AMP), resting motion threshold (RMT), and central motor conduction time (CMCT) scores over the 2-week course of therapy. In both groups, scores were evaluated at baseline, 1 week from commencing therapy, and post-therapy. After 2 weeks, the HABIT group showed improved scores as compared the CRP group for FMA (51.7 ± 6.44 vs. 43.5 ± 5.6, P < 0.001), ARAT (34.5 ± 6.2 vs. 33.3 ± 6.3, P = 0.022), and AMP (1.1 ± 0.1 vs. 1.0 ± 0.1, P < 0.001). However, CMCT (8.6 ± 1.0 vs. 9.1 ± 0.6, P = 0.054) and RMT (55.3 ± 4.2 vs. 57.5 ± 4.1, P = 0.088) were similar when comparing between groups. HABIT significantly improved motor functional and neuro-physiological outcomes in patients with acute stroke, which suggested that HABIT might represent an improved therapeutic strategy as compared CRP.