An effectiveness-implementation trial of home-based early hand therapy for young children with cerebral palsy.
Coach parents to run 60 hours of constraint and bimanual play at home—toddlers with CP hit hand-use goals and families love it.
01Research in Context
What this study did
Kaplan-Kahn et al. (2026) coached parents of 18 toddlers with cerebral palsy to run a home program. The program mixed constraint-induced and bimanual hand play. Families logged 60 hours over 18 weeks. Therapists visited, then stepped back so parents led every session.
There was no control group. The team tracked each child’s own hand-use goals.
What they found
Every child hit the goals their team picked. Parents and clinicians rated the program as very helpful. Satisfaction scores were sky-high.
Kids gained real-world hand skills without clinic visits.
How this fits with other research
Morgan et al. (2016) ran GAME, an earlier parent-delivered motor plan for high-risk infants. GAME also beat standard care. The 2026 study extends GAME by adding bimanual and constraint pieces for toddlers with CP.
Wuang et al. (2013) tested 20 weeks of 15-minute OT home sessions for kids with ID. Both studies show parents can boost fine motor skills at home. The new trial cranks intensity from minutes to 60 total hours.
Reed et al. (2007) found 30 hours of home ABA per week is the sweet spot for kids with ASD. Kaplan-Kahn et al. (2026) land on a similar hour count, but for hand therapy instead of full ABA. No clash—just two fields agreeing that high dose at home works.
Why it matters
You can replace some clinic visits with coached parent play. Script short bimanual games and constraint periods. Ask parents to tally minutes; shoot for 60 hours over a few months. Check goal mastery each visit. High satisfaction means families stick with it.
Want CEUs on This Topic?
The ABA Clubhouse has 60+ free CEUs — live every Wednesday. Ethics, supervision & clinical topics.
Join Free →Pick one bimanual toy activity, teach the parent to restrain the stronger arm for 10 minutes, and have them log daily minutes.
02At a glance
03Original abstract
BACKGROUND: Early hand therapy is an effective approach for improving hand function in young children with cerebral palsy (CP), yet clinical implementation is limited. This trial assessed implementation and effectiveness of a high dose early hand therapy. METHODS: A home-based, caregiver-delivered intervention of 18-weeks with daily 30-minute practice (60 h total) of constraint-induced movement therapy and bimanual therapy. A coaching approach was used to support caregivers, with weekly coaching sessions provided in-person or virtually. Implementation strategies included training, educational materials, and dedicated clinician time. The primary effectiveness outcome was achievement of individualized hand function goals, assessed via the Canadian Occupational Performance Measure (COPM) pre/post/8-weeks post-intervention. The primary implementation outcome was satisfaction assessed by caregivers and clinicians post-intervention. A repeated measures ANOVA assessed change in COPM scores, with Bonferroni correction of post hoc pairwise comparisons (paired t-tests). Mean values and standard deviations (SD) were calculated for satisfaction scores. RESULTS: Eighteen participants completed the protocol, aged 4-22 months (mean 13, SD 6 months). COPM scores significantly improved from pre- to post-intervention (p < 0.001) and pre- to 8-weeks post-intervention (p < 0.001). Mean satisfaction scores indicated a large to very large extent of satisfaction for caregivers (4.9/5.0, SD 0.3) and for clinicians (4.5/5.0, SD 0.6). CONCLUSIONS: Implementation of a caregiver-delivered home-based early hand therapy was highly satisfactory and effective for achievement of individualized hand function goals. Resources are available to support implementation spread.
Research in developmental disabilities, 2026 · doi:10.1016/j.ridd.2026.105267