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

Abstract

Background. High-intensity training aims to improve hand function in children with unilateral spastic cerebral palsy (USCP). However, the extent to which skill training is required is not known. Objectives. To compare the effects of intensive bimanual training with and without structured progression of skill difficulty, on manual dexterity, bimanual hand use, daily functioning, and functional goals in children with USCP. Method. Twenty-two children were randomized to structured practice group (SPG) or unstructured practice group (UPG), and received 6 h/d training during 15 days. Children from the SPG were engaged in fine and gross motor bimanual activities, with skill progression and goal training. Children from UPG performed the same activities without skill progression or goal training. Participants were evaluated before, immediately and 6 months after training by a physical therapist blinded to group allocation. The primary outcomes were the Jebsen-Taylor Test of Hand Function (JTTHF) and Assisting Hand Assessment (AHA). Secondary outcomes included the Canadian Occupational Performance Measure (COPM), Pediatric Evaluation of Disability Inventory (PEDI), and ABILHAND-Kids. Results. Both groups showed similar improvements in the JTTHF, AHA, ABILHAND-Kids, COPM-satisfaction, and PEDI ( P < .05). A significant interaction in the COPM-performance scale ( P = .03) showed superior improvements of the SPG immediately, but not 6 months, after the intervention. Conclusions: Children from both groups demonstrated improvements in dexterity and functional hand use. This suggests that for intensive bimanual approaches, intensive training at such high doses may not require structured practice to elicit improvements. However, there may be immediate added benefit of including goal training.