Statement of the Problem
Children with bilateral cerebral palsy (BCP) oftentimes have difficulty coordinating their hands to perform bimanual tasks. However, the characteristics of bimanual coordination in children with BCP have not yet been explored. Furthermore, although intensive motor learning-based interventions such as Hand-Arm Bimanual Intensive Training Including the Lower Extremities, (HABIT-ILE) are aimed at improving bimanual function in children with BCP, there is no evidence, to date, that bimanual coordination improves in these children following interventions such as HABIT-ILE. Since the Both Hands Assessment (BoHA) is the only validated measure of bimanual performance in children with BCP, this study also sought to determine whether the kinematic measure of bimanual coordination used in this study as well as the BoHA are both responsive to change following HABIT-ILE.
Methods
Vicon motion capture was used to collect 3-D kinematic data during a drawer-opening task to compare bimanual coordination in 14 children with BCP with that of 14 typically developing children (TDC) using speed and hand constraints. Children with BCP classified at Manual Ability Classification System (MACS) levels I to III were also evaluated on the Box and Blocks Test (BBT), a test of unimanual dexterity, and the BoHA. The BoHA uses video analysis to evaluate spontaneous use of both hands during a board game. Correlations between temporal measures of bimanual coordination and these clinical measures of hand function and asymmetry were also examined. A subset of 6 children with BCP were evaluated on the drawer-opening task and the BoHA pre- and post-HABIT-ILE to determine the effect of HABIT-ILE on both bimanual coordination and performance and to compare the responsiveness to change between these two measures.
Results
Compared to TDC, children with BCP performed the bimanual task more slowly (p < 0.001) and sequentially, as evidenced by greater time differences between the two hands completing the two components of the task (p < 0.05). Performing the task at a faster speed facilitated bimanual coordination, particularly in children with BCP (p < 0.05). The use of the less affected hand to initiate the more complex component of the task under speeded conditions also had a greater facilitatory effect on bimanual coordination in children with BCP (p = 0.02). Bimanual coordination measures correlated significantly with clinical measures of hand function and asymmetry. For instance, faster task completion times correlated with higher BBT scores (Spearman’s rho ranged from r = -0.74 to r = -0.82). Following HABIT-ILE, children with BCP improved on several temporal measures of bimanual coordination (r = -0.64; p = 0.03) and the BoHA (r = -0.61; p = 0.03).
Conclusion
This study found significant differences in bimanual coordination between children with BCP and TDC. It also highlighted the facilitatory effect of faster speeds and hand role on bimanual coordination. Correlations between temporal measures of bimanual coordination and clinical measures of hand function suggest that children with BCP with lesser impairment of both hands are better able to coordinate their hands to perform bimanual tasks. Following HABIT-ILE, children with BCP improved significantly on several temporal measures of bimanual coordination as well as the BoHA. Thus, this study demonstrated that both a kinematic measure of bimanual coordination as well as a measure that relies on video analysis of bimanual performance were both responsive to change following HABIT-ILE.
| Identifer | oai:union.ndltd.org:columbia.edu/oai:academiccommons.columbia.edu:10.7916/3v5g-h526 |
| Date | January 2023 |
| Creators | Herard, Grace-Anne M. |
| Source Sets | Columbia University |
| Language | English |
| Detected Language | English |
| Type | Theses |
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