Posts Tagged Bimanual training

[Abstract] Error-augmented bimanual therapy for stroke survivors

via Error-augmented bimanual therapy for stroke survivors – IOS Press

, , , , , , , , , ,

Leave a comment

[ARTICLE] Including a Lower-Extremity Component during Hand-Arm Bimanual Intensive Training does not Attenuate Improvements of the Upper Extremities: A Retrospective Study of Randomized Trials – Full Text

Hand-Arm Bimanual Intensive Therapy (HABIT) promotes hand function using intensive practice of bimanual functional and play tasks. This intervention has shown to be efficacious to improve upper-extremity (UE) function in children with unilateral spastic cerebral palsy (USCP). In addition to UE function deficits, lower-extremity (LE) function and UE–LE coordination are also impaired in children with USCP. Recently, a new intervention has been introduced in which the LE is simultaneously engaged during HABIT (Hand-Arm Bimanual Intensive Therapy Including Lower Extremities; HABIT-ILE). Positive effects of this therapy have been demonstrated for both the UE and LE function in children with USCP. However, it is unknown whether the addition of this constant LE component during a bimanual intensive therapy attenuates UE improvements observed in children with USCP. This retrospective study, based on multiple randomized protocols, aims to compare the UE function improvements in children with USCP after HABIT or HABIT-ILE. This study included 86 children with USCP who received 90 h of either HABIT (n = 42) or HABIT-ILE (n = 44) as participants in previous studies. Children were assessed before, after, and 4–6 months after intervention. Primary outcomes were the ABILHAND-Kids and the Assisting Hand Assessment. Secondary measures included the Jebsen-Taylor Test of Hand Function, the Pediatric Evaluation of Disability Inventory [(PEDI); only the self-care functional ability domain] and the Canadian Occupational Performance Measure (COPM). Data analysis was performed using two-way repeated-measures analysis of variance with repeated measures on test sessions. Both groups showed similar, significant improvements for all tests (test session effect p < 0.001; group × test session interaction p > 0.05) except the PEDI and COPM. Larger improvements on these tests were found for the HABIT-ILE group (test session effect p < 0.001; group × test session interaction p < 0.05). These larger improvements may be explained by the constant simultaneous UE–LE engagement observed during the HABIT-ILE intervention since many daily living activities included in the PEDI and the COPM goals involve the LE and, more specifically, UE–LE coordination. We conclude that UE improvements in children with USCP are not attenuated by simultaneous UE–LE engagement during intensive intervention. In addition, systematic LE engagement during bimanual intensive intervention (HABIT-ILE) leads to larger functional improvements in activities of daily living involving the LE.


Cerebral palsy (CP) is the most common cause of pediatric motor disability with a prevalence ranging from 2 to 3.6 out of 1,000 children in western countries (12). Motor disorders are often accompanied by sensation, perception, cognition, behavior, communication, and epilepsy disorders (1). Although the lesions are established from birth and are non-progressive, the motor impairments experienced by children with CP affect their autonomy and functional outcomes during their life-span. Moreover, motor symptoms such as impaired ability to walk may worsen during development (3).

One of the most disabling long-term functional deficits in children with unilateral spastic cerebral palsy (USCP) is impaired manual dexterity, i.e., impaired skilled hand movements and precision grip abilities (4). Upper-extremity (UE) impairments may affect functional independence, especially for activities of daily living requiring bimanual coordination (e.g., buttoning one’s shirt). It is now well known that intensive interventions based on motor skill learning principles and goal-directed training are effective for improving UE function in children with USCP (5). Constraint-Induced Movement Therapy (CIMT) was the first intensive intervention adapted to children with USCP (6). CIMT was first designed for adults with stroke and subsequently adapted to children with USCP showing improvements in hand function (5). Taking advantage of the key ingredient of CIMT (intensive practice with the affected UE), Charles and Gordon developed an alternative intensive bimanual approach termed “Hand-Arm Bimanual Intensive Therapy” (HABIT) (7). HABIT was developed with recognition that the combined use of both hands was necessary to increase functional independence in children with USCP (7). Focusing on improving bimanual coordination through structured play and functional activities during HABIT demonstrated efficacy to improve UE function in children with USCP (5).

Both HABIT and CIMT focus only on the UE of children with USCP. Though the lower extremity (LE) is generally less affected than UE in children with USCP, impairments observed in the affected LE range from an isolated equine ankle to hip flexion and adduction with a fixed knee (8). Children with USCP are then unable to achieve postural symmetry while standing, systematically presenting with an overload on one bodyside (8). They also frequently encounter limitations in walking abilities (3). Besides the LE impairments, UE–LE coordination is often impaired in children with USCP (910). This coordination is frequently used in daily living activities (e.g., walking while carrying an object in the hand, climbing stairs while using the railing). A program that simultaneously trains the UE and LE in children with USCP is thus of interest since the UE impairments in children with CP remain stable through time (11) while walking and other LE abilities may decline during development (3). In 2014, taking advantage of the key ingredients in HABIT (intensive bimanual practice), Bleyenheuft and Gordon developed a new intervention focusing on both the UE and LE entitled “Hand-Arm Bimanual Intensive Therapy Including Lower Extremities” (HABIT-ILE) (12). Positive effects of this therapy focusing on both the UE and LE through structured play and functional activities have been demonstrated both for the UE and the LE of children with USCP (13) as well as, more recently, for children with bilateral CP (14). However, it is unknown whether the introduction of a systematic LE engagement in addition to a bimanual intervention may lead to attenuated improvements in UE compared to traditional HABIT due to shifts in attention (multitasking). This retrospective study aimed to compare changes in the UE of children with USCP undergoing 90 h of intensive bimanual intervention either with (HABIT-ILE) or without (HABIT) a LE component. We hypothesized that the introduction of systematic LE training simultaneously added to the bimanual training would lead to reduced improvements in the UE during HABIT-ILE compared to traditional HABIT. […]

Continue —> Frontiers | Including a Lower-Extremity Component during Hand-Arm Bimanual Intensive Training does not Attenuate Improvements of the Upper Extremities: A Retrospective Study of Randomized Trials | Neurology

, , , , , , ,

Leave a comment

[Abstract] The effect of bilateral arm training on motor areas excitability in chronic stroke patients



Physical therapy exercises that do not enhance motor areas neuroplasticity lead to motor impairment especially at the upper extremity (UE) in the chronic stroke patients. The aim of this study was to assess the effect of using bilateral arm training on motor areas excitability (neuroplasticity) in the chronic stroke patients.


Thirty male chronic stroke patients with moderate impairment of UE were assigned into two equal groups. The changes of motor areas excitability (neuroplasticity) were assessed before and after arm training by spectral analysis of mapping electroencephalogram (EEG). Delta, theta, alpha, beta 1 and beta 2 waves were recorded. The equation which was used to detect the neural plasticity and the changing at motor areas excitability was dividing the fast wave/slow waves or detecting the ratio of mean frequency of (beta 2 + beta 1 + alpha/theta + delta).


Patients in group 1 (G1) received unilateral arm training and patients in group 2 (G2) received bilateral arm training. The Results: Showed significant increase in the excitability (neuroplasticity) at (F4 + F8) and (C4) motor areas in G2 comparing to G1 (p!9 .006) and (p!9 .036 ) respectively.


Bimanual training leads to activation of extensive networks in both hemispheres.


It was concluded that bilateral arm training is a recommended method to enhance the motor areas excitability (neuroplasticity) in the chronic stroke patients.


Post stroke physical therapy can make use of bimanual training for better rehabilitation.

Source: S185 The effect of bilateral arm training on motor areas excitability in chronic stroke patients – Clinical Neurophysiology

, , , , , , , ,

Leave a comment

[WEB SITE] Constraint therapy


Information last checked: April 2013

Constraint Induced Movement Therapy (CIMT) PDF 730KB

What were we asked?

A parent wanted to know if there was any evidence that constraint induced movement therapy (CIMT) was effective at improving manual ability in children with hemiplegia.

What did we do?

In 2012 we searched a range of academic databases including NHS Evidence, the Cochrane Library, TRIP database, NICE guidelines and Pubmed for evidence and articles on this topic.  This search was updated in April 2013.

What did we find?

What is CIMT?

CIMT is a therapy for children with hemiplegia which involves encouraging use of the affected arm while restricting use of the unaffected arm. The initial version of CIMT involved a strict regimen. Modified versions of CIMT vary in the therapy regimen, the frequency and duration, and type of constraint.  In this summary, we use CIMT as an umbrella term to include modified versions of the therapy.

  • Different types of constraint include gloves, mitts, casts, slings or splints.  Mitts and gloves are commonly used as they restrict the unaffected arm whilst still allowing for the arm to be used in the event of a trip or fall.
  • CIMT has been carried out at home, preschool, hospital or at a designated camps, and in some cases parents and carers have been trained to deliver the therapy.
  • There are some concerns about whether constraint has a detrimental or harmful effect in the long term, and whether the ‘non-impaired’ arm is wholly unaffected.1
  • The number of randomised controlled trials (RCTs) investigating this treatment has increased in recent years, which suggests a growing interest in the therapy.

What studies were found?

Continue —> Peninsula Cerebra Research Unit.

, , ,

Leave a comment

%d bloggers like this: