Summary

Cerebral palsy (CP) is the most common cause of severe physical disability in childhood. Spastic hemiplegia, characterized by motor impairments largely affecting one side of the body, is the most common form of CP. The resulting impaired hand function is one of the most disabling symptoms of hemiplegia, affecting self-care activities such as feeding, dressing and grooming. Consequently, children with hemiplegic CP tend not to use the more affected extremity. This “developmental non-use” can lead to further deficits, most notably affecting bimanual coordination. To date, there is unfortunately little evidence of efficacy of any specific treatment approach. Nevertheless, several lines of evidence suggest the impairments are not static. Upper extremity performance in children with CP may improve with practice and development, indicating that hand function may well be amenable to treatment. In this chapter we review this evidence along with studies involving intensive unilateral practice; i.e. constraint-induced movement therapy (CIMT). We then discuss important limitations of CIMT (most importantly, bimanual impairments underlie functional limitations) and introduce a new form of intensive training to address these limitations: Hand–Arm Bimanual Intensive Training (HABIT). The clinical implications of these findings and future directions for pediatric rehabilitation research are discussed.

Introduction

Cerebral palsy (CP) is a development disorder of movement and posture causing limitations in activity and deficits in motor skill (Bax et al., 2005) and is attributed to non-progressive disturbances in the developing fetal or infant brain.