The Effect of Home-Based Intensive Lower Extremity Training on Gross Motor Function in Children with Cerebral Palsy: A Randomized Controlled Trial

Abstract

Cerebral palsy (CP) commonly causes motor disturbances affecting balance impairment and local movement. While Hand-Arm Bimanual Intensive Therapy Including Lower Extremities (HABIT-ILE) shows promise, its comparative benefits compared to conventional therapy require critical assessment. Therefore, the objective of this study was to compare the effects of HABIT-ILE with conventional therapy and conventional therapy alone on lower limb performance in children with CP. A randomized controlled trial having 44 children with CP aged between 5-12 years was randomized to either: (1) 6-week HABIT-ILE (60 hours) plus conventional therapy (n=22), or (2) conventional therapy alone (n=22). Gross Motor Function Measure-66 (GMFM-66) was taken as the primary outcome. The secondary outcomes consisted of the 6-Minute Walk Test (6MWT), and the Pediatric Balance Scale (PBS). Measures were done at Baseline, end of the intervention, and 3 months follow-up. The results showed that both groups significantly improved the GMFM-66 (HABIT-ILE p<0.001; and control p<0.001), and the difference between the groups was not significant (p=0.34). HABIT-ILE showed more gains than PBS within the context of minimal clinically important difference on a 1-4 cm scale (+4.3 vs +3.1 points; p=0.04). A between-group difference was not found in 6MWT (p=0.72). Subgroup analysis indicated that children with GMFCS Level II obtained the highest gains in HABIT-ILE balance. We concluded that although both the interventions enhanced gross motor function, HABIT-ILE gave certain benefits in the balance, especially in the children who belong to Gross Motor Function Classification System (GMFCS) II. Such results are helpful to justify the rehabilitation strategies focusing on a certain functional profile.