Unimanual versus bimanual therapy in children with unilateral cerebral palsy: Same, same, but different

Issue title: Pediatric Constraint Induced Movement Therapy: Harnessing Adaptive Neuroplasticity

Guest editors: Frank S. Pidcock

Article type: Research Article

Authors: Hoare, Brian^{a; b; *} | Greaves, Susan^{a; c}

Affiliations: [a] Department of Paediatrics, Monash University, Clayton, Victoria, Australia | [b] CPtherapy, Australian Catholic University, Victoria, Australia | [c] Occupational Therapy Department, The Royal Children's Hospital, Victoria, Australia

Correspondence: [*] Corresponding author: Brian Hoare, Paediatric Rehabilitation Department, Monash Children's Hospital, 246 Clayton Road, Clayton, Vic 3168, Australia. Tel.: +61 3 9594 4620; Fax: +61 3 9594 6136; E-mail:[email protected]

Abstract: BACKGROUND: There is high-level evidence supporting constraint-induced movement therapy (CIMT) and bimanual therapy for children with unilateral cerebral palsy. Evidence-based intervention includes time-limited, goal-directed, skills-based, intensive blocks of practice based on motor learning theory. AIM AND METHODS: Using supporting literature and clinical insight, we provide a theoretical rationale to highlight previously unreported differences between CIMT and bimanual therapy. DISCUSSION: The current emphasis on total dosage of practice for achieving positive outcomes fails to recognise the influence of other critical concepts within motor learning. Limitations exist in the application of motor learning principles using CIMT due to its unimanual nature. CIMT is effective for development of unimanual actions brought about by implicit learning, however it is difficult to target explicit learning that is required for learning how to use two hands together. Using bimanual therapy, object properties can be adapted to trigger goal-related perceptual and cognitive processes required for children to learn to recognise when two hands are required for task completion. CONCLUSION: CIMT and bimanual should be viewed as complementary. CIMT could be used to target unimanual actions. Once these actions are established, bimanual therapy could be used for children to learn how to use these actions for bimanual skill development.

Keywords: Cerebral palsy, constraint-induced movement therapy, bimanual therapy, motor learning theory

DOI: 10.3233/PRM-170410

Journal: Journal of Pediatric Rehabilitation Medicine, vol. 10, no. 1, pp. 47-59, 2017