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Early Intensive Bimanual Stimulation Program (BB-Bim) for Infants at Risk of Unilateral Cerebral Palsy: A Randomized, Multiple-Baseline, Single-Case Study

American Journal of Occupational Therapy, ISSN: 1943-7676, Vol: 77, Issue: 6
2023
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Article Description

Importance: Clinical practice guidelines for infants at high risk of cerebral palsy (CP) emphasize the importance of very early and intensive intervention. Objective: To determine the feasibility of a new, home-based, early intensive bimanual stimulation program (BB–Bim) and its impact on hand function in infants at risk of unilateral CP. Design: Single case experimental design, multiple baseline across subjects, lasting from 12 to 15 wk, including a 4- to 7-wk randomized baseline, followed by 8 wk of BB–Bim. Setting: Home. Participants: Infants (ages 3–12 mo) with suspected unilateral CP, whose parents agreed to participate in the stimulation program. Intervention: Parent-provided bimanual stimulation 20 min/day, 6×/wk, with weekly occupational therapist coaching visits. Measures: Weekly repeated measures were the Hand Assessment in Infants (HAI) and Goal Attainment Scaling (GAS). Feasibility and relevance were assessed with a logbook and a parental report, including 10 continuous 0–10 scaled questions. Results: Six infants were included (2 with left and 4 with right brain lesions). Parents provided a mean 3.4 to 6.2 stimulation sessions/wk. Feasibility and relevance were highly rated (Ms 5 8.2–9.6, SDs 5 0.2–1.3). Stimulation significantly improved HAI bimanual and total scores for all infants, with no impact on HAI unilateral scores. GAS scores improved with stimulation (significant for 3 infants). Conclusions and Relevance: BB–Bim was feasible and tended to improve bimanual function in infants at risk of unilateral CP.

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