Tests & Measures: A Resource for Pediatric Physical Therapy Practitioners

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

Title

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

Purpose

The purpose of this study was to determine the effectiveness of HABIT-ILE (Hand-arm bimanual intensive therapy including lower extremity) on children with bilateral impairments form cerebral palsy.

Methods

Study Population: 20 children were included in the study. 10 were placed in the intervention group and 10 in the control group. These participants were from Brussels and New York (10 included from each).

Inclusion Criteria

Bilateral Cerebral Palsy in the CMFCS levels II-IV, between the ages 6-16, able to grab objects and lift 15cm above a table with most affected upper extremity, no cognitive impairments, and able to follow directions.

Exclusion Criteria

Children were excluded if they have had botox injections in the last 6 months, uncontrolled seizures, difficulties with vision, unable to walk a few steps with an assistive device such as a walker.

Intervention

A HABIT-ILE camp was held in Brussels (6 participants) and New York (4 participants) and consisted of 13 days of camp with 6.5 hours a day of intense interventions (84. 5 hours of treatment) designed with activities get harder throughout the week during camp and encourages critical thinking and repetition of skills that incorporate upper and lower body coordination.

During the activities if a child had the ability to complete an activity with 3/5 accuracy, the activity was made more challenging for either UE or LE, but not both.

The control group received normal therapy for two weeks consisting of a mean of 2.8 hours of care each of the two weeks during the study.

Outcome Measures

Outcome measures were used pre-test, post test, and follow up after three months. This study was divided into primary and secondary outcome measures. The primary outcome measures include the Gross Motor Function Scale and ABILHAND-kids. The secondary outcome measures were further divided into two groups, upper extremity and lower extremity. Upper extremity secondary outcome measures include Pediatric Evaluation of Disability Inventory, Box and Blocks, Jebsen-Taylor Test of Hand Function. Secondary lower extremity outcome measures include ABILOCO-kids, Pediatric Balance Scale, and 6-Minute Walk Test.

Results

Participants in the HABIT-ILE group showed statistical significant improvements on post-hoc testing for post test and follow up for ABILHAND-kids, Pediatric Evaluation of Disability Inventory, GMFM-66, 6 Minute Walk Test, Pediatric Balance Scale, however, no statistical significant differences noted on the ABILICO-kids between the groups despite improvement in the HABIT-ILE group. No significant differences noted in the control group on the outcome measures.

Strengths

The utilization of many outcome measures pre and post test/follow provides support that the HABIT-ILE camp makes significant improvements in function for UE/LE. For example, the 6 Minute Walk Test post hock testing showed that children walked more meters during the 6 minutes at post test and follow up from pre test.

Limitations

This study had a small sample size, with a total of 20 participants, and 10 in control and 10 in intervention group,. Additionally, the follow up time of three months is short due to the possibility of skewed results because of other interventions a child may receive. A longer follow up time would allow researchers to see if there is carryover longer than three months for the HABIT-ILE intervention.

 

Conclusion

Participating in the 13 day HABIT-ILE camp can have significant improvements in overall UE/LE functioning for children with bilateral cerebral palsy. It is important to note that these changes are most likely due to increased neural drive due to the short time frame.

 

Reference

Bleyenheuft Y, Ebner-Karestinos D, Surana B, Paradis J, Sidiropoulos A, Renders A, Friel KM, Brandao M, Rameckers E, Gordon AM. Intensive upper- and lower-extremity training for children with bilateral cerebral palsy: a quasi-randomized trial. Developmental Medicine & Child Neurology. 2017;59(6):625-633. doi:10.1111/dmcn.13379.