The Impact of Dosing Schedule on the Efficacy of Hand–Arm Bimanual Intensive Therapy Including the Lower Extremities (HABIT-ILE) in Children With Bilateral Cerebral Palsy

Background Recent studies indicate that 60 to 90 hours of motor learning-based interventions provided over a 2 to 3 weeks period improve upper and lower extremity function, balance, and trunk control in children with bilateral cerebral palsy (BCP). However, this treatment dose and schedule may not be feasible for many families and treatment centers. The present study aimed to determine whether a distributed dosing schedule spread out over a longer period would yield gains and retention of functional motor skills and activity. Methods Following randomization, 21 children age 5 to 17 years with BCP participated in a 90-hour Hand–Arm Bimanual Intensive Therapy Including the Lower Extremities (HABIT-ILE) program provided in either a massed (6 hours/day, 5 days/week for 3 weeks) or distributed (6 hours/day, 1 day/week for 15 weeks) dosing schedule. Primary outcomes included upper extremity dexterity (Box and Blocks Test), gross motor function (Gross Motor Function Measure-66), and trunk control (Trunk Control Measurement Scale). Results Both dosing schedules led to significant gains in upper and lower extremity function, balance, and trunk control ( P < .05 on all primary measures). Overall, there was not an advantage of 1 dosing schedule over the other. Conclusions A distributed model of HABIT-ILE can produce similar gains and retention in gross motor function, manual dexterity, balance, and trunk control in children with BCP. The findings may allow clinicians more flexibility in decision-making with regard to the delivery method to fit the preferences for family routines, potentially increasing the feasibility of implementing intensive therapies into clinical practice. Trial Registration Number NCT03940989.