The Influence of Intense Combined Training on Upper Extremity Function in Children With Unilateral Cerebral Palsy: Does Initial Ability Matter?

Aim: To examine whether level of manual ability modifies the response to an intensive program combining modified constraint and bimanual training on arm functioning children with unilateral cerebral palsy (UCP). Methods: Thirty-four children aged 6–11 years, with Manual Ability Classification System (MACS) levels I–III (I:8, II:15, III:11), participated in a 2-week program, combining an hour of modified constraint with 5 hr of bimanual practice daily. The Assisting Hand Assessment (AHA) and the Jebsen–Taylor Test of Hand Function (JTTHF) were done pre-, post-, and 3-months post-intervention. Results: Mean AHA logits unit scores increased overtime (F_2;50 = 5, p = 0.01). There was no significant difference in AHA logits units change score between MACS levels (F_4;56 = 1.4, p = 0.22). JTTHF scores did not change for either the affected or less-affected hand, although a significant interaction of time and MACS level was found in the less-affected side (F_4;58 = 6.5, p < 0.01). Children in MACS levels I and II improved by similar degrees, in comparison to children at MACS level III who demonstrated significantly greater change over time. Conclusion: While a similar trend of improvement was found in the bimanual abilities of children at all MACS levels, only children at MACS level III had improved performance in unilateral abilities in the less-affected side following intervention.