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

Brandão, Marina de Brito; Ferre, Claudio L; Kuo, Hsing‐Ching; Rameckers, Eugène; Bleyenheuft, Yannick; Hung, Ya-Ching; Friel, Kathleen M.; Gordon, Andrew M.

doi:10.1177/1545968313516871

Cited by 43 publications

(71 citation statements)

References 45 publications

(79 reference statements)

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“…Forty-two randomized trials were included in the original systematic review and a further 18 were identified from the subsequent search (Abd ElKafy, Elshemy, & Alghamdi, 2014;Bleyenheuft, Arnould, Brandao, Bleyenheuft, & Gordon, 2014;Brandao, Ferre, Kuo, Rameckers, Bleyenheuft, Hung et al, 2013;Chiu, Ada, & Lee, 2014;Deppe, Thuemmler, Fleischer, Berger, Meyer, & Wiedemann, 2013;Dong & Fong, 2014;Ferrari, Maoret, Muzzini, Alboresi, Lombardi, Sgandurra et al, 2014;Gelkop, Burshtein, Lahav, Brezner, Al-Oraibi, Ferre et al, 2014;Gilliaux, Renders, Dispa, Holvoet, replication of the intervention. No study adequately reported all of these seven core elements.…”

Section: Resultsmentioning

confidence: 99%

Do we really know what they were testing? Incomplete reporting of interventions in randomised trials of upper limb therapies in unilateral cerebral palsy

Sakzewski

Reedman

Hoffmann

2016

Research in Developmental Disabilities

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Background: Incomplete reporting of components of interventions limits uptake of evidence into clinical practice. Aims:To evaluate the completeness of reporting of research and control interventions in randomised trials of upper limb therapies for children with unilateral cerebral palsy. Methods and procedures:Sixty randomized trials were included, encompassing 60 research and 68 control interventions. Using the 12-item Template for Intervention Description and Replication (TIDieR) checklist, two reviewers independently rated intervention and control descriptions.Outcomes and results: When using 50% of studies as the benchmark, five of the 12 TIDieR items for the research intervention, eight of the 12 items for the control intervention and 11 of 12 items for "usual care" interventions were inadequately reported. Procedures used to deliver the research intervention were adequately reported for 63% of studies. Materials were used in 94% of research interventions, yet only 27% provided details to access/replicate materials. Training materials for interventionists were used in 38% of trials, 10 (17%) had procedure manuals, yet only 3 reported details to access materials. The location where the research intervention was provided was detailed in 65% of studies. Reporting of all items was poorer for the control intervention. Conclusions:No study adequately reported all elements on the TIDieR checklist. Details crucial for replication of interventions and interpretation of results were missing. Authors, reviewers, and editors all have a responsibility to improve the quality of intervention reporting in published trials. The TIDieR guide is a potential solution, helping to structure accounts of interventions. What this study adds:This is the first study 3  This is the first study to evaluate the completeness of reporting of intervention components in complex cerebral palsy interventions  This is the first study to rate completeness of reporting of control interventions  This study provides information to increase awareness of editors, reviewers and authors of the importance of complete reporting of intervention components in cerebral palsy rehabilitation.

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Section: Resultsmentioning

confidence: 99%

Do we really know what they were testing? Incomplete reporting of interventions in randomised trials of upper limb therapies in unilateral cerebral palsy

Sakzewski

Reedman

Hoffmann

2016

Research in Developmental Disabilities

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“…Eighteen children were randomized to either structured HABIT (n=8, structured skill group) or unstructured bimanual play (n=10, unstructured practice group), performed in separate rooms. Motor outcomes from these children have been published in a larger randomized clinical trial that included twenty-two children 8 . Eighteen of the children in the RCT also participated in this TMS mapping study.…”

Section: Methodsmentioning

confidence: 99%

“…The AHA quantifies the effectiveness of assisting hand use in performing bimanual activities in children with unilateral upper limb disabilities. The AHA has excellent validity, reliability (0.97-0.99) and responsiveness to change 8,31 . The test was videotaped and scored off-site by an experienced blinded evaluator.…”

Section: Methodsmentioning

confidence: 99%

“…Task difficulty systematically increases as motor proficiency progresses, further enhancing improvement 7 . We recently showed that HABIT improves unimanual skill, bimanual hand use, and functional hand use 8 . Given the functional impact of training, it is important to determine how training affects the brain.…”

Section: Introductionmentioning

confidence: 99%

“…Children in the unstructured practice group performed bimanual movements during play, but did not progress skill of activities, nor practice isolated movements or functional goals. In the structured skill training group, task difficulty was increased by imposing greater spatial or temporal constraints, or by providing tasks that required increased skilled use and problem solving 7,8 . An example is placing a game board farther away from the child, to encourage a farther reach as a child’s arm extension increased.…”

Section: Introductionmentioning

confidence: 99%

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Skilled Bimanual Training Drives Motor Cortex Plasticity in Children With Unilateral Cerebral Palsy

Friel

Kuo

Fuller

et al. 2016

Neurorehabil Neural Repair

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115

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Background Intensive bimanual therapy can improve hand function in children with unilateral spastic cerebral palsy (USCP). We compared the effects of structured bimanual skill training vs. unstructured bimanual practice on motor outcomes and motor map plasticity in children with USCP. Objective We hypothesized that structured skill training would produce greater motor map plasticity than unstructured practice. Methods Twenty children with USCP (average age 9,5; 12 males) received therapy in a day-camp-setting, 6 h/day, 5 days/week, for 3 weeks. In structured skill training (n=10), children performed progressively more difficult movements and practiced functional goals. In unstructured practice (n=10), children engaged in bimanual activities but did not practice skillful movements or functional goals. We used the Assisting Hand Assessment (AHA), Jebsen-Taylor test of Hand Function (JTTHF) and Canadian Occupational Performance Measure (COPM) to measure hand function. We used single-pulse transcranial magnetic stimulation (TMS) to map the representation of first dorsal interosseous (FDI) and flexor carpi radialis (FCR) muscles bilaterally. Results Both groups showed significant improvements in bimanual hand use (AHA; p<0.05) and hand dexterity (JTTHF; p<0.001). However, only the structured skill group showed increases in the size of the affected hand motor map and amplitudes of motor evoked potentials (p<0.01). Most children who showed the most functional improvements (COPM) had the largest changes in map size. Conclusions These findings uncover a dichotomy of plasticity: the unstructured practice group improved hand function but did not show changes in motor maps. Skill training is important for driving motor cortex plasticity in children with USCP.

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Changes Induced by Early Hand-Arm Bimanual Intensive Therapy Including Lower Extremities in Young Children With Unilateral Cerebral Palsy

Araneda,

Ebner-Karestinos,

Paradis

et al. 2024

JAMA Pediatr

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ImportanceIntensive interventions are provided to young children with unilateral cerebral palsy (UCP), classically focused on the upper extremity despite the frequent impairment of gross motor function. Hand-Arm Bimanual Intensive Therapy Including Lower Extremities (HABIT-ILE) effectively improves manual dexterity and gross motor function in school-aged children.ObjectiveTo verify if HABIT-ILE would improve manual abilities in young children with UCP more than usual motor activity.Design, Setting, and ParticipantsThis prospective randomized clinical trial (November 2018 to December 2021), including 2 parallel groups and a 1:1 allocation, recruitment took place at European university hospitals, cerebral palsy specialized centers, and spontaneous applications at 3 sites: Brussels, Belgium; Brest, France; and Pisa, Italy. Matched (age at inclusion, lesion type, cause of cerebral palsy, and affected side) pairs randomization was performed. Young children were assessed at baseline (T0), 2 weeks after baseline (T1), and 3 months after baseline (T2). Health care professionals and assessors of main outcomes were blinded to group allocation. At least 23 young children (in each group) aged 12 to 59 months with spastic/dyskinetic UCP and able to follow instructions were needed. Exclusion criteria included uncontrolled seizures, scheduled botulinum toxin injections, orthopedic surgery scheduled during the 6 months before or during the study period, severe visual/cognitive impairments, or contraindications to magnetic resonance imaging.InterventionsTwo weeks of usual motor activity including usual rehabilitation (control group) vs 2 weeks (50 hours) of HABIT-ILE (HABIT-ILE group).Main Outcomes and MeasuresPrimary outcome: Assisting Hand Assessment (AHA); secondary outcomes: Gross Motor Function Measure-66 (GMFM-66), Pediatric Evaluation of Disability Inventory-Computer Adaptive Test (PEDI-CAT), and Canadian Occupational Performance Measure (COPM).ResultsOf 50 recruited young children (26 girls [52%], median age; 35.3 months for HABIT-ILE group; median age, 32.8 months for control group), 49 were included in the final analyses. Change in AHA score from T0 to T2 was significantly greater in the HABIT-ILE group (adjusted mean score difference [MD], 5.19; 95% CI, 2.84-7.55; P &lt; .001). Changes in GMFM-66 (MD, 4.72; 95% CI, 2.66-6.78), PEDI-CAT daily activities (MD, 1.40; 95% CI, 0.29-2.51), COPM performance (MD, 3.62; 95% CI, 2.91-4.32), and satisfaction (MD, 3.53; 95% CI, 2.70-4.36) scores were greater in the HABIT ILE group.Conclusions and RelevanceIn this clinical trial, early HABIT-ILE was shown to be an effective treatment to improve motor performance in young children with UCP. Moreover, the improvements had an impact on daily life activities of these children.Trial registrationClinicalTrials.gov Identifier: NCT04020354

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

Cited by 43 publications

References 45 publications

Do we really know what they were testing? Incomplete reporting of interventions in randomised trials of upper limb therapies in unilateral cerebral palsy

Do we really know what they were testing? Incomplete reporting of interventions in randomised trials of upper limb therapies in unilateral cerebral palsy

Skilled Bimanual Training Drives Motor Cortex Plasticity in Children With Unilateral Cerebral Palsy

Changes Induced by Early Hand-Arm Bimanual Intensive Therapy Including Lower Extremities in Young Children With Unilateral Cerebral Palsy

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