HABIT-ILE Therapy Effective for Enhancing Motor Skills in Children with Unilateral Cerebral Palsy

Recent research on Unilateral cerebral palsy (UCP) that poses a significant challenge for young children offered new hope in the form of Hand-Arm Bimanual Intensive Therapy Including Lower Extremities, known as HABIT-ILE, which demonstrated promising outcomes in enhancing both manual dexterity and gross motor function among young children with UCP. The trial results were published in the journal JAMA Pediatrics. 

Cerebral palsy is the most common pediatric motor neuron disease occurring before the age of 2 years. As atypical brain development causes CP, compromising skilled movements like activities of daily living are affected. Previous research suggested that intensive goal-directed interventions based on motor skill learning help to improve motor function and daily activities. Most interventions targeted the upper extremities despite the impairment in the lower extremities. Hence, researchers conducted a trial to verify if HABIT-ILE would improve manual abilities in young children with UCP more than usual motor activity.

HABIT-ILE is Hand-Arm Bimanual Intensive Therapy Including Lower Extremities (HABIT-ILE) done to improve manual dexterity and gross motor function in school-aged children.

The prospective randomized clinical trial was conducted between November 2018 and December 2021 across European university hospitals, cerebral palsy specialized centers, and spontaneous applications in Brussels, Belgium, Brest, France, and Pisa, Italy. The study utilized matched pairs randomization, taking into account variables such as age at inclusion, lesion type, cause of cerebral palsy, and affected side. The inclusion criteria specified children aged 12 to 59 months with spastic/dyskinetic UCP who could follow instructions, while exclusion criteria encompassed factors such as uncontrolled seizures, planned botulinum toxin injections, or orthopedic surgery scheduled during the study period.

The trial involved two groups: one received two weeks of usual motor activity, including standard rehabilitation (control group), while the other underwent two weeks (equivalent to 50 hours) of HABIT-ILE therapy (HABIT-ILE group).

The primary outcome measured was the Assisting Hand Assessment (AHA), while secondary outcomes included the Gross Motor Function Measure-66 (GMFM-66), Pediatric Evaluation of Disability Inventory-Computer Adaptive Test (PEDI-CAT), and Canadian Occupational Performance Measure (COPM).

Results

• Out of the 50 young children recruited for the study (26 girls, a median age of 35.3 months in the HABIT-ILE group, and a median age of 32.8 months in the control group), 49 were included in the final analysis.
• The findings revealed a significant improvement in the AHA score from baseline to the three-month mark in the HABIT-ILE group.
• Changes in GMFM-66, PEDI-CAT daily activities, COPM performance, and satisfaction scores were also notably greater in the HABIT-ILE group. 

This clinical trial provided compelling evidence that early intervention with HABIT-ILE is an effective approach for enhancing motor performance in young children with UCP. Moreover, the improvements observed had a tangible impact on the daily life activities of these children. These findings hold the promise of improving the quality of life for young children grappling with UCP, offering new avenues for treatment and support. 

Further reading: Araneda R, Ebner-Karestinos D, Paradis J, et al. Changes Induced by Early Hand-Arm Bimanual Intensive Therapy Including Lower Extremities in Young Children With Unilateral Cerebral Palsy: A Randomized Clinical Trial. JAMA Pediatr. Published online November 06, 2023. doi:10.1001/jamapediatrics.2023.4809