Efficacy of Hand Arm Bimanual Intensive Therapy in Improving Real-World Bimanual Performance and Identifying Predictors for Therapy Success in Children with Unilateral Cerebral Palsy.

Abstract

Aim: This study assesses real-world bimanual performance improvements following Hand-Arm Bimanual Intensive Therapy (HABIT) using an objective tool (accelerometers) and to identify demographic and clinical predictors of these gains in children with unilateral cerebral palsy (UCP).

Methods: Forty children with UCP (mean age: 10.7 ± 3.24 years) participated in 30 h of HABIT. Bilateral wrist-worn accelerometers measured bimanual performance using use ratio, bilateral magnitude, and median acceleration. Self-perceived performance was measured using the Canadian Occupational Performance Measure (COPM), and upper extremity (UE) capacity with Jebsen-Taylor Hand Function Test (JTHFT), Nine-Hole Peg Test (NHPT), and Box and Block Test (BBT). Predictors such as age, sex, affected side, severity levels, and baseline capacity were analyzed.

Results: Use ratio (p = .02) and median acceleration (p = .04) showed improvements, indicating enhanced real-world performance. Gains were observed in COPM (performance and satisfaction, p = .001) and UE capacity (JTHFT: p = .001, NHPT: p = .02, and BBT: p = .01). Age, baseline NHPT and JTHFT scores explained 40.7% of the variance in use ratio, while NHPT accounted for 11.5% of the variance in median acceleration.

Conclusion: HABIT enhances real-world bimanual performance in children with UCP. Older age and more impaired baseline dexterity are significant predictors of greater therapeutic gains, offering potential strategy to maximize real-world functional gains.