Caregiver‐directed home‐based intensive bimanual training in young children with unilateral spastic cerebral palsy: a randomized trial

• Published in: Developmental medicine and child neurology 2017-05, Vol.59 (5), p.497-504
• Main Authors: Ferre, Claudio L, Brandão, Marina, Surana, Bhavini, Dew, Ashley P, Moreau, Noelle G, Gordon, Andrew M
• Format: Article
• Language: English
• Subjects: Caregivers; Cerebral Palsy - complications; Child; Child, Preschool; Exercise Therapy - methods; Female; Functional Laterality - physiology; Hand - physiopathology; Home Care Services; Humans; Lower Extremity - physiopathology; Male; Muscle Spasticity - etiology; Muscle Spasticity - rehabilitation; Outcome Assessment (Health Care)
• ISSN: 0012-1622; 1469-8749
• DOI: 10.1111/dmcn.13330

Aim To examine the efficacy of caregiver‐directed, home‐based intensive bimanual training in children with unilateral spastic cerebral palsy (USCP) using a randomized control trial. Method Twenty‐four children (ages 2y 6mo–10y 1mo; 10 males, 14 females) performed home‐based activities directed by a caregiver for 2 hours per day, 5 days per week, for 9 weeks (total=90h). Cohorts of children were age‐matched into groups and randomized to receive home‐based hand‐arm bimanual intensive therapy (H‐HABIT; n=12) or lower‐limb functional intensive training (LIFT‐control; n=12). Caregivers were trained before the intervention and supervised remotely via telerehabilitation. Dexterity and bimanual hand function were assessed using the Box and Blocks test (BBT) and the Assisting Hand Assessment (AHA) respectively. Caregiver perception of functional goals was measured using the Canadian Occupational Performance Measure (COPM). Results H‐HABIT showed greater improvement on the BBT compared to LIFT‐control and no improvement on the AHA. H‐HABIT demonstrated significant improvement in COPM‐Performance compared to LIFT‐control and both groups showed equal improvement in COPM‐Satisfaction. Interpretation H‐HABIT improved dexterity and performance of functional goals, but not bimanual performance, in children with USCP compared to a control group receiving intervention of equal intensity/duration that also controlled for increased caregiver attention. Home‐based models provide a valuable, family‐centered approach to achieve increased treatment intensity. What this paper adds Caregivers can play an active role in providing bimanual training to children with unilateral spastic cerebral palsy. Home‐based intensive bimanual training improves dexterity and functional goals. Supervision of caregivers may play an important role in ensuring treatment fidelity. This article is commented on by Eliasson on page 456 of this issue.