HABIT-ILE: A randomised trial of hand arm bimanual intensive training including lower extremity training for children with bilateral cerebral palsy

HABIT-ILE is a motor learning approach simultaneously addressing coordination of the upper and lower limbs. Key elements of HABIT-ILE are: Dose: We will deliver a total dose of 65 hours of HABIT-ILE. The 65 hours of HABIT-ILE will be achieved through a 2 week intensive group delivered day camp for 6.5 hrs/day over 10 days. The model of HABIT-ILE to be tested has been adapted to maximise future clinical translation to ensure acceptability and feasibility to children with bilateral CP and their families in Australia. Mode: Groups of 10-12 children delivered (1:1 or 2:1 therapist / volunteer / student to child ratio according to ability). Content and tailoring: Upper extremity: Intervention will be based on the child’s motor abilities (determined at baseline), age, interests and self-identified functional goals. Tasks/activities are made incrementally more challenging. Practice is structured, using whole task practice with high repetition and ongoing feedback about performance. Tasks that will be performed include: (i) incremented table top fine motor activities; (ii) activities of daily living when standing/walking; (iii) gross motor play and physical activities. Based on the pilot study of HABIT-ILE, we expect that 40% of the time will be spent engaged in activities requiring gross upper limb dexterity, 30% on activities of daily living, 20% manipulative games, and 10% on other card games, arts and crafts. Lower extremity: Based on the child’s motor abilities, postural control/sitting balance will be progressed from sitting on a stool to sitting on fitness balls to build core strength; progression of standing balance with use of balance boards. Based on the pilot study of HABIT-ILE, we expect that sessions will be structure so that 40% of time is spent sitting on fitness balls, 20% sitting on stools, 20% standing and 20% walking/running. Intervention providers: Physiotherapists and occupational therapists delivering HABIT-ILE will complete standardised training provided by the developer of HABIT-ILE. This will coincide with the first intensive intervention camp conducted. The trained therapists will in turn train and supervise therapy students and coach parents to deliver HABIT-ILE. Target intensity: We expect that sessions will be structured so that 40% of time is spent sitting on fitness balls, 20% sitting on stools, 20% walking/running, 40% of the time will be spent engaged in activities requiring gross upper limb dexterity, 30% on activities of daily living, 20% manipulative games, and 10% on other card games, arts and crafts. Fidelity: Standardised therapist training will be provided to therapists employed to deliver the intervention. the training package will include: • Intervention manual • Onsite training during the first HABIT-ILE camp lead by a master trainer Training sessions will be video recorded and accessible at any time for established or new therapists delivering the intervention. All group intervention sessions will be videotaped and a random selection viewed for fidelity adherence and competence criteria.