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

Aims: 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 (2hrs/day, 5days/week for 9weeks) 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.