Hand-arm 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.

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.

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

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.

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.

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.

Does Dosage Matter? A Pilot Study of Hand-Arm Bimanual Intensive Training (HABIT) Dose and Dosing Schedule in Children with Unilateral Cerebral Palsy

ABSTRACTAim: We compared the efficacy of hand-arm bimanual intensive training (HABIT) in two doses (90 vs. 45 hours) and two schedules of the same dose (90 vs. 2 × 45 hours) on hand and daily functioning. Method: Eighteen children with unilateral cerebral palsy were randomized to receive 6 hours of daily training over 3 weeks, totaling 90 hours (Group 90, n = 9) or receive 6 hours of daily training over 1.5 weeks, totaling 45 hours (Group 2 × 45, n = 9). After 6 months, Group 2 × 45 received an additional 45 hours. Hand (Jebsen–Taylor Test of Hand Function, Assisting Hand Assessment) and daily functioning tests (Canadian Occupational Performance Measure, Pediatric Evaluation of Disability Inventory) were administered before, immediately after, and 6 months after interventions. Results: Both groups demonstrated significant improvements in hand and daily functioning after 90 hours (Group 90) or the first 45 hours (Group 2 × 45), without differences between groups. However, more children from Group 90 obtained smallest detectable differences in the Assisting Hand Assessment. The addition of the second bout of 45 hours (Group 2 × 45) did not lead to further improvements. Conclusions: As this study was powered to test for large differences between groups, future investigations on larger samples will be needed to compare differences at the two dosage levels.

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.

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.

Comparison between Effectiveness of Hand Arm Bimanual Intensive Training and Repetitive Facilitation Exercises on Upper Limb Functions In Post Stroke Hemiparetic Patients

Comparison between Effectiveness of Hand Arm Bimanual Intensive Training and Repetitive Facilitation Exercises on Upper Limb Functions In Post Stroke Hemiparetic Patients

The effects of hand‐arm bimanual intensive training (HABIT) in children with bilateral cerebral palsy: preliminary results of a randomized controlled trial

The effects of hand‐arm bimanual intensive training (HABIT) in children with bilateral cerebral palsy: preliminary results of a randomized controlled trial

Improvements in Kinematic Performance After Home-Based Bimanual Intensive Training for Children with Unilateral Cerebral Palsy

ABSTRACTAims: To evaluate the effects of home-based intensive bimanual training for children with unilateral spastic cerebral palsy (USCP) on bimanual coordination using 3-D kinematic analyses. Methods: Seven children with USCP (aged 29–54 months, MACS level: I-III) received 90 hours (2 hrs/day, 5days/week for 9 weeks) of Home Hand-Arm Bimanual Intensive Training (H-HABIT) provided by trained caregivers. A bimanual drawer-opening task was evaluated with eight infrared cameras using VICON workstation4.6 before and after training to assess improvements in bimanual coordination. Results: H-HABIT training significantly decreased the time between one hand opening the drawer and the other hand manipulating its contents (p < 0.05) and increased the percentage of time when both hands were moving simultaneously (p = 0.001), which are indicators of improved temporal bimanual coordination. In addition, participants demonstrated a 26% decrease in trunk displacement (p < 0.05), a 30% increase in upper arm joint excursion (p < 0.01), and a 25% increase in elbow extension (p < 0.05) for the affected side. All the improvements were maintained at 6-month posttest. Conclusions: H-HABIT improved not only temporal, but also quality of movement during a bimanual task for seven children with USCP. Thus, H-HABIT could be an alternative or adjunctive treatment for children with USCP.

Effect of Manipulating Object Shape, Size and Weight Combined with Hand- Arm Bimanual Intensive Training (HABIT) in Improving Upper Extremity Function in Children with Hemiplegic Cerebral Palsy-A Randomized Controlled Trial

Background: Hand Arm Bimanual Intensive Training (HABIT) has proven to improve upper extremity performance and co-ordination in children with hemiplegia. Children with unilateral spastic cerebral palsy display deficits in motor planning and execution that impact the timing and co-ordination of joint movements, orientation of the hand to object size, shape, weight and use, and calibration of fingertip forces. Bilateral impaired modulation of aperture, decreased bilateral ability to orient the hand prior to object contact based on forthcoming actions with the object was also reported. Objective: To study the effect of Manipulating object shape, size and weight combined with Hand-arm bimanual intensive training(HABIT) in improving actual use of the more affected arm for completing activities commonly carried out in daily life, child's ability to handle objects and reducing spasticity in children with hemiplegic cerebral palsy. Material and method: Thirty patients who fulfilled the inclusion criteria were randomly allocated into two groups. Group A-HABIT with Object Manipulation, Group B- HABIT without Object Manipulation with 15 patients in each group. All the patients were evaluated with Pediatric Motor Activity Log, Modified Ashworth Scale and Manual Ability Classification System at pre-and post-treatment level. Results: There were significant decrease in spasticity MAS (p=0.001) & improvement in upper extremity function PMAL-R (p=0.001) & MACS (p=0.001) in both the groups post intervention. HABIT with object manipulation with different shape & size group had significant improvement on PMAL-R (p=0.002) & MACS (p=0.009) but no change in spasticity MAS (p=0.679) as compared to HABIT with object manipulation with similar shape & size group. Conclusion: From finding of this study conclude that HABIT with Object Manipulation with different shape and size have positive effect in improving upper extremity function in children with hemiplegic cerebral palsy but not in spasticity reduction after 4 weeks of intervention.

Functional Impact of Constraint Therapy and Bimanual Training in Children With Cerebral Palsy: A Randomized Controlled Trial

We compared children's self-care performance and caregivers' perception of children's performance on functional goals established for children with hemiplegic cerebral palsy (CP) after unimanual constraint-induced movement therapy (CIMT) or hand-arm bimanual intensive training (HABIT). Sixteen children with CP were randomized to the CIMT or HABIT group. Interventions lasted for 15 days, 6 hr/day, totaling 90 hr. We used the Pediatric Evaluation of Disability Inventory and the Canadian Occupational Performance Measure (COPM) to assess the children's daily functioning and mixed analyses of variance to compare group means on functional test scores before and after intervention. Both groups showed significant improvements on functional measures. Group × Assessment interaction in COPM performance revealed greater improvements for the HABIT group after intervention (p = .04). The results suggest that specificity of training exists only for performance of specific goals established by parents and that both CIMT and HABIT can be used to increase children's daily functioning.

Systematic Review and Meta-analysis of Therapeutic Management of Upper-Limb Dysfunction in Children With Congenital Hemiplegia

Rehabilitation for children with congenital hemiplegia to improve function in the impaired upper limb and enhance participation may be time-consuming and costly. To systematically review the efficacy of nonsurgical upper-limb therapeutic interventions for children with congenital hemiplegia. The Cochrane Central Register of Controlled Trials, Medline, CINAHL (Cumulative Index to Nursing and Allied Health Literature), AMED (Allied and Complementary Medicine), Embase, PsycINFO, and Web of Science were searched up to July 2008. Data sources were randomized or quasi-randomized trials and systematic reviews. Twelve studies and 7 systematic reviews met our criteria. Trials had strong methodologic quality (Physiotherapy Evidence Database [PEDro] scale > or = 5), and systematic reviews rated strongly (AMSTAR [Assessment of Multiple Systematic Reviews] score > or = 6). Four interventions were identified: intramuscular botulinum toxin A combined with upper-limb training; constraint-induced movement therapy; hand-arm bimanual intensive training; and neurodevelopmental therapy. Data were pooled for upper-limb, self-care, and individualized outcomes. There were small-to-medium treatment effects favoring intramuscular botulinum toxin A and occupational therapy, neurodevelopmental therapy and casting, constraint-induced movement therapy, and hand-arm bimanual intensive training on upper-limb outcomes. There were large treatment effects favoring intramuscular botulinum toxin A and upper-limb training for individualized outcomes. No studies reported participation outcomes. No one treatment approach seems to be superior; however, injections of botulinum toxin A provide a supplementary benefit to a variety of upper-limb-training approaches. Additional research is needed to justify more-intensive approaches such as constraint-induced movement therapy and hand-arm bimanual intensive training.