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Dev Med Child Neurol. 2017 Jun;59(6):625-633. doi: 10.1111/dmcn.13379. Epub 2017 Jan 30.

Intensive upper- and lower-extremity training for children with bilateral cerebral palsy: a quasi-randomized trial.

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Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium.
Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA.
Physical and Rehabilitation Medicine Department, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium.
Burke-Cornell Medical Research Institute, White Plains, NY, USA.
Departamento de Terapia Ocupacional, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
Research in Function and Rehabilitation, Rehabilitation Medicine, CAPHRI, Maastricht University, Maastricht, the Netherlands.
Center of Expertise, Adelante Rehabilitation, Hoensbroek, the Netherlands.
Avans Plus, Breda, the Netherlands.



An approach that simultaneously engages both the upper and lower extremities, hand-arm bimanual intensive therapy including lower extremity (HABIT-ILE), has recently demonstrated improvements in upper and lower extremities in children with unilateral cerebral palsy (CP). It is not known whether children with bilateral CP would benefit from this approach. The aim of this study was to examine the efficacy of HABIT-ILE in children with bilateral CP.


A quasi-randomized trial design was used, whereby 20 participants (age 6-15y, Gross Motor Function Classification System levels II-IV, Manual Ability Classification System levels I-III) were assigned to a treatment (HABIT-ILE) or a comparison group in the order in which they were enrolled. Children in the HABIT-ILE group were assessed before and after 84 hours of intervention over 13 days, as well as at 3 months' follow-up. Children in the comparison group were assessed at the same time points. Children in both groups were assessed using the Gross Motor Function Measure (GMFM-66) and ABILHAND-Kids (primary measures), and six secondary measures.


A group×test session interaction indicated significant improvements in the HABIT-ILE group as assessed by the GMFM-66, lower-extremity performance (6-Minute Walk Test; Pediatric Balance Scale), functional upper-extremity abilities (ABILHAND-Kids/Pediatric Evaluation of Disability Inventory), and the dexterity of the less affected upper extremity.


HABIT-ILE is efficacious for improving both upper- and lower-extremity function in children with bilateral CP.

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