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

Aim: 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. Method: 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. Results: 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. Conclusion: HABIT-ILE is efficacious for improving both upper- and lower-extremity function in children with bilateral CP.