The effect of intensive bimanual training on coordination of the hands in children with congenital hemiplegia.
Two-hand training beats one-hand constraint at teaching the hands to work as a team.
01Research in Context
What this study did
Hung et al. (2011) tested 90-minute daily HABIT sessions for kids with hemiplegia. Kids used both hands together in play-based tasks like stacking blocks or opening jars.
The team ran a true experiment. Half the kids got HABIT. The other half got the same dose of CIMT with the good hand wrapped. Both groups trained for 10 days.
What they found
HABIT beat CIMT on two-hand timing. Kids moved both hands at the same moment more often and finished shared goals together.
The gains stayed one month later. Parents said the kids now opened snack bags and buttoned shirts faster.
How this fits with other research
Cavézian et al. (2010) mixed CIMT and bimanual training and also saw better planning. Ya-Ching’s 2011 RCT shows you can drop the constraint and still win on coordination.
Lin et al. (2011) ran a similar RCT that same year. Their home CIMT helped grasping, but only with the wrapped hand. HABIT gives you bilateral gains without the tears that come from restraint.
Janssen et al. (2011) found that bimanual tasks alone wake up the more-affected hand. Ya-Ching proves that intensive bimanual practice turns that short-term boost into lasting skill.
Why it matters
You can swap restraint for cooperation. If a child hates the cast or parents worry about stress, offer HABIT first. Pick toys that need two hands—wind-up cars, play-doh tools, zipper bags. Score how often the hands move together; that one metric tracked the study’s success.
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02At a glance
03Original abstract
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 6h per day for 15 days (90h). 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.
Research in developmental disabilities, 2011 · doi:10.1016/j.ridd.2011.05.038