The effect of intensive bimanual training on coordination of the hands in children with congenital hemiplegia

Recent studies have suggested efficacy of intensive bimanual training in improving the quality and quantity of affected hand use in children with hemiplegia. However, it is not known whether such training affects the coordination of the two hands. In the present study, 20 children with congenital hemiplegia (age 4-10 years; MACS levels I-II) were randomly assigned to either an intensive bimanual training (Hand-Arm Bimanual Intensive Therapy: HABIT) group, or a control group consisting of equally intensive unimanual treatment (Constraint-Induced Movement Therapy, CIMT) for 6 h per day for 15 days (90 h). To assess their bimanual coordination, children were asked to open a drawer with one hand and manipulate its contents with the other hand. 3-D movement kinematics were recorded and subsequently analyzed by a blind evaluator. The role of the two hands was varied. Following treatment, superior improvement in bimanual coordination was found for the bimanual training group as indicated by greater movement overlap (the percentage of time with both hands engaged in the task p = 0.047) and better goal synchronization (reduced time differences between the two hands completing the task goals, p = 0.005). The results suggest that bimanual training improves the spatial-temporal control of the two hands, and are in agreement with the principle of practice specificity.