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.
Shailesh S Gardas, Katie Woosley, Caroline Brown and 7 others
PMID 40456004WHAT IT FOUND
In children with unilateral cerebral palsy, 30 hours of bimanual therapy increased real-world affected-hand use and self-reported performance, but one movement measure did not change.
No control group.
Key findings
01HABIT increased use ratio and median acceleration, but bilateral magnitude did not change.
02Children's self-reported bimanual performance improved by 6.1 points and satisfaction by 8.8 points, both above the 2-point minimum clinically important difference.
03Older age and slower baseline Nine Hole Peg Test and Jebsen-Taylor Hand Function Test scores predicted greater use-ratio gains, and baseline Nine Hole Peg Test scores predicted median-acceleration gains.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
There was no control group, so natural growth, maturation, or other daily experiences cannot be separated from HABIT. The paper reports 42 participants enrolled and completed the intervention, but also says 40 children participated and completed HABIT, and some children had accelerometer data errors, so the analysed sample is unclear. The sample was mostly male, 31 boys and 9 girls, so sex differences cannot be assessed. Accelerometers record arm movement, including non-purposeful arm swings, and wearing them may make children use their arms differently. No minimum clinically important difference exists for accelerometer outcomes in children with unilateral cerebral palsy. Predictor models used a small set of variables and were not tested in subgroups.
The easy way to misread this
Do not conclude that 30 hours of HABIT caused the real-world gains. The study had no control group, so development, daily life, or simply wearing the accelerometers could explain some changes. Also, bilateral magnitude did not improve.