Hand Arm Bimanual Intensive Therapy (HABIT) Improves Spatiotemporal Characteristics of Bimanual Coordination in Children with Unilateral Cerebral Palsy

Abstract

Unilateral cerebral palsy (UCP) causes sensorimotor impairments on one side of the body and affects bimanual coordination, causing difficulty in the performance of functional tasks and affecting independence in daily life. HABIT is effective in improving bimanual function; however, results of previous studies typically rely on standard assessments. There is limited evidence to understand preciseness of bimanually coordinated movements. The objective of this study is to assess the efficacy of HABIT on spatiotemporal characteristics of bimanual coordination. The study included 25 participants with UCP (age=11.2 ± 3.6 yrs; 18M, 7F). HABIT was provided in a camp-based setting where participants engaged in structured, task-based bimanual activities in play context 6hrs/day for 5 days. To assess spatiotemporal characteristics, 3-dimensional motion analysis (3DMA) was used to analyze variables of two cup-stacking tasks (symmetric performance and bimanual cooperation), pre- and post-HABIT. In the symmetric task, the child grasped a cup in each hand and concurrently placed them into targeted areas. In the bimanual cooperation task, they stacked 6 cups in a pyramid formation. Variables measured included peak speed, task completion time, hand path distance, and normalized movement overlap time. A 2×2 ANOVA was used to compare spatiotemporal changes with time (pre-, post-HABIT) and UEs (affected and non-affected) as factors for all kinematic variables. Post-HABIT, in the bimanual coordination task, significant gains (p<0.05) were observed in task completion time (pre= 15.05 ± 1.9, post= 10.09 ± 1.08) and movement overlap (pre= 0.5 ± 0.02, post= 0.93 ± 0.01), indicating enhanced speed and bimanual participation. There was a significant interaction (time × limb [F (1,54)]= 5.2, p= 0.02) for peak speed. Increased speed in affected UE post-HABIT suggests enhanced fluency of movements. There was no significant interaction in hand path distance; however, there were significant main effects of time (pre= 3.2 ± 0.16, post= 2.7 ± 0.14, p= 0.001) and limb (affected= 2.5 ± 0.2, non-affected= 3.3 ± 0.2, p= 0.004). For the symmetric task, there were no significant changes in task completion time and no time × limb interactions for hand speed and path distance. Based on these results, HABIT improves spatiotemporal characteristics of bimanual coordination.