The Effect of Bimanual Training with or Without Constraint on Hand Functions in Children with Unilateral Cerebral Palsy: A Non-Randomized Clinical Trial

Aim: To compare the effect of bimanual training with or without constraint on manual functions in children with unilateral cerebral palsy (UCP). Methods: Seventeen children aged 6-11 years with UCP participated in one of two intensive therapeutic camps: bimanual (n = 9) incorporating one hour of constraint ("Hybrid") or Bimanual (n = 8). Each camp met for 2 weeks, 5 days per week for 6 hours each day. The Assisting Hand Assessment (AHA) and the Jebsen Taylor Test of Hand Function (JTTHF) examined bimanual and unimanual functions pre, post-and 3-months post-intervention. Results: A significant improvement was noted in AHA scores for both groups between the pre-, post- and three months post-intervention [Hybrid (F2; 16 = 85.5, p < 0.01); Bimanual (F2; 16 = 15.4, p < 0.01)] with no significant differences between groups over time (F2; 30 = 0.74, p = 0.48). For the JTTHF, a significant improvement was noted in the affected hand following the Hybrid program (F2; 30 = 7.45, p = 0.01), while following the Bimanual program a significant difference was noted only in the less-affected hand (F2; 16 = 6.02, p < 0.01]. Conclusion: Both interventions Hybrid and Bimanual were similarly effective for improving use of the affected hand in bimanual tasks. The unique contribution of each intervention, the Hybrid program on the affected and the Bimanual on the less-affected side, warrants further examination.