AUTHOR=Saussez Geoffroy , Brandão Marina B. , Gordon Andrew M. , Bleyenheuft Yannick 

TITLE=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

JOURNAL=Frontiers in Neurology

VOLUME=Volume 8 - 2017

YEAR=2017

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2017.00495

DOI=10.3389/fneur.2017.00495

ISSN=1664-2295

ABSTRACT=Hand-Arm Bimanual Intensive Training (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 90h of either HABIT (n= 42) or HABIT-ILE (n= 44) as participants in previous studies. Children were assessed before, after and 4 to 6 months after intervention. Primary outcomes were the ABILHAND-Kids and the Assisting Hand Assessment (AHA). Secondary measures included the Jebsen-Taylor Test of Hand Function (JTTHF), the Pediatric Evaluation of Disability Inventory (PEDI; only the self-care functional ability domain) and the Canadian Occupational Performance Measure (COPM). Data analysis were performed using two-way repeated measures ANOVA with repeated measures on test sessions. Both groups showed similar, significant improvements for all tests (test session effect p<0.001; group x 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 x 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