Structured skill practice during intensive bimanual training leads to better trunk and arm control than unstructured practice in children with unilateral spastic cerebral palsy

Abstract

Background: Recently, intensive practice showed good efficacy in improving upper extremity function for children with unilateral spastic cerebral palsy (USCP). However, little is known about the significance of skill progression frequently used during intensive practice.

Aims: We evaluate the importance of skill progression during intensive bimanual practice on movement coordination.

Methods and procedures: Twenty children with USCP (average age: 8.5; MACS levels: I-III) participated in the study. Ten children were randomly allocated to a structured practice group (SPG) with skill progression, and the other 10 children randomized to an unstructured practice group (UPG) without skill progression. Both groups practiced bimanual activities 6h a day for 15days. Children were asked to perform a bimanual drawer-opening task before and after intensive practice using 3-D kinematic analyses.

Outcomes and results: Both groups showed improved temporal bimanual coordination with increased normalized movement overlap of the two hands (p=0.005) and decreased goal synchronization time (p=0.002). However, only the SPG showed decreased trunk involvement (p=0.01) and increased elbow joint excursion (p=0.017) with decreased variability (p=0.015 and 0.048 respectively).

Conclusions and implications: The results highlighted the importance of skill progression for intensive practice to improve upper extremity and trunk movement control and consistency for children with USCP.

Keywords: Hemiplegia; Kinematics; Pediatric; Rehabilitation; Upper extremity.