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Neurorehabil Neural Repair. 2013 Dec 27;28(5):452-461. [Epub ahead of print]

Comparison of Structured Skill and Unstructured Practice During Intensive Bimanual Training in Children With Unilateral Spastic Cerebral Palsy.

Author information

  • 1Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil.
  • 2Teachers College, Columbia University, New York, NY, USA.
  • 3Maastricht University, Maastricht, Netherlands University for Professionals for Pediatric Physical Therapy, AVANSplus, Breda, Netherlands.
  • 4Université Catholique de Louvain, Brussels, Belgium.
  • 5Queens College, City University of New York, Flushing, NY, USA.
  • 6Burke-Cornell Medical Research Institute, White Plains, NY, USA.
  • 7Teachers College, Columbia University, New York, NY, USA


Background. High-intensity training aims to improve hand function in children with unilateral spastic cerebral palsy (USCP). However, the extent to which skill training is required is not known. Objectives. To compare the effects of intensive bimanual training with and without structured progression of skill difficulty, on manual dexterity, bimanual hand use, daily functioning, and functional goals in children with USCP. Method. Twenty-two children were randomized to structured practice group (SPG) or unstructured practice group (UPG), and received 6 h/d training during 15 days. Children from the SPG were engaged in fine and gross motor bimanual activities, with skill progression and goal training. Children from UPG performed the same activities without skill progression or goal training. Participants were evaluated before, immediately and 6 months after training by a physical therapist blinded to group allocation. The primary outcomes were the Jebsen-Taylor Test of Hand Function (JTTHF) and Assisting Hand Assessment (AHA). Secondary outcomes included the Canadian Occupational Performance Measure (COPM), Pediatric Evaluation of Disability Inventory (PEDI), and ABILHAND-Kids. Results. Both groups showed similar improvements in the JTTHF, AHA, ABILHAND-Kids, COPM-satisfaction, and PEDI (P < .05). A significant interaction in the COPM-performance scale (P = .03) showed superior improvements of the SPG immediately, but not 6 months, after the intervention. Conclusions: Children from both groups demonstrated improvements in dexterity and functional hand use. This suggests that for intensive bimanual approaches, intensive training at such high doses may not require structured practice to elicit improvements. However, there may be immediate added benefit of including goal training.

© The Author(s) 2013.


bimanual training; cerebral palsy; constraint-induced movement therapy; goal practice; hand; hand-arm bimanual intensive training (HABIT); hemiplegia; intensive rehabilitation; training ingredients; upper extremity

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