Effectiveness of Intensive and Distributed Bilateral Intensive Training for Children With Unilateral Cerebral Palsy

Importance: Bilateral intensive training (BIT) has promising effects for children with unilateral cerebral palsy (UCP), but the effectiveness of different dosing schedules remains unclear. Objective: To compare the efficacy of two dosing schedules of BIT (intensive and distributed) in children with UCP. Design: Secondary analysis. Setting: Community. Participants: Thirty-five children with UCP ages 6 to 12 yr. Intervention: Each group received 36 training hours: intensive BIT within 1 wk and distributed BIT twice weekly over 8 wk. Outcomes and Measures: Motor outcomes were assessed using the Box and Block Test, Melbourne Assessment 2, Pediatric Motor Activity Log–Revised, Bruininks–Oseretsky Test of Motor Proficiency 2, ABILHAND–Kids, and Parenting Stress Index–Short Form. The intensive group was evaluated at Weeks 0, 1, and 8; the distributed group was evaluated at Weeks 0 and 8. Results: Both dosing schedules yielded similar improvements immediately posttreatment and at Week 8. The intensive BIT group exhibited significantly greater enhancements in the quality and frequency of the more affected hand’s use in daily activities compared with the distributed BIT group at Week 8. No significant differences were observed in bilateral hand use between groups. Parental stress levels remained stable across both intervention schedules. Conclusions and Relevance: Both intensive and distributed BIT schedules yielded similar improvements, with intensive BIT providing additional benefits in daily use of the more affected hand. Both schedules are feasible and well tolerated and do not increase parental stress, supporting their potential for broader application in different clinical settings. Plain-Language Summary: This study compared the efficacy of two intervention schedules of bilateral intensive training (intensive and distributed) in children with unilateral cerebral palsy. Both intensive and distributed bilateral intensive training schedules demonstrated similar outcomes immediately after a 36-hour intervention. However, the intensive bilateral intensive training schedule led to greater improvement in the daily use of the more affected hand at an 8-week follow-up. This suggests that strengthening both the ability and habit of using the more affected hand can result in sustained improvements over time. Notably, we observed the transfer of these enhanced motor skills to daily activities in unilateral hand use but not in bilateral hand use. This discrepancy may be attributed to the complexity of bilateral coordination, highlighting the need for occupational therapist guidance. In summary, the similar improvements in motor outcomes between the two intervention schedules suggest that the total amount of training hours is the critical factor for bilateral motor improvement rather than the distribution of those hours.