Hand/Arm Bimanual Intensive Training

Hand-Arm Bimanual Intensive Therapy (HABIT) is a new type of physical therapy intervention developed at Columbia University.  Its chief aim is to improve the use of both arms in daily function.

How is HABIT different from constraint-induced use therapy (CI)?

Like constraint-induced use therapy therapy, HABIT requires 90 hours of intensive therapy and it is performed in group settings with an emphasis on having fun. But unlike CI therapy, HABIT focuses on improving the ability to perform bimanual activities. The efficacy of this new bimanual treatment for improving coordination with two hands has not been tested on children post-hemispherectomy;  however, to date, initial results of testing in the broader cerebral palsy cohort indicate good efficacy.  It is the belief of researchers at Columbia University that efficacy of hand rehabilitation is not dependent on the use of restrictive devices on the unaffected hand.  Although CI appears to be an effective treatment strategy for many individuals with CP, it is not likely effective for children who have mild or  severely impacted hand function. Additionally, the goal of proper hand function is not to use on hand alone, but to use the two hands together for activities requiring bimanual function (i.e. catching a ball, typing, cooking.)  Because typically-developing children use both hands together, it is the goal of HABIT to promote this use.

Is HABIT a child-friendly therapy?

Yes, and researchers believe more so than CI.  Children can get very frustrated when their “good arm” is constrained, some to the point of regression of skills.  Moreover, a child with other orthopedic impairments (such as limited ambulation) or cognitive delays, are at greater risk of falling and injuring their “good arm” during serial casting.  HABIT, which does not use any serial casting whatsoever, eliminates these issues.