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Effect of alternating inter-manual training on hand shaping during grasp in children with unilateral spastic cerebral palsy
Aviva Wolff, EdD, OTR, CHT1; Howard Hillstrom, PhD1; Andrew Gordon, PhD2
1Hospital for Special Surgery, New York, NY; 2Teachers College Columbia University, New York, NY

Introduction
Children with unilateral spastic cerebral palsy (USCP) demonstrate impairment in grasp control in the affected hand. This study tests the effect of alternating inter-manual training (AIM), a novel form of inter-manual training, on hand-shaping, a component of reach-to-grasp, in children with USCP.

Materials and Methods
Two groups of children (n=20, ages 6-18 years) with USCP were age matched to 2 practice groups: AIM training group and control group (CON). All subjects grasped a rectangle, convex, or concave shape during 3-dimensional motion capture analysis. For each shape, data were collected in a single session during 3 phases: pre-test (10 trials), training-test (the last 10 of 25 training trials), and post-test (10 trials). In the training phase, the AIM group reached, grasped, and lifted each shape in an alternating fashion first with the less affected hand followed by the affected hand. The control group alternated lifts with a sham object (rubber ball). A visuomotor efficiency index (VME) was calculated to quantify hand shaping during reach-to-grasp (100=perfect discrimination). The VME, derived from all hand joint angles at multiple intervals throughout reach, provides temporal-spatial information on the evolution of hand posture discrimination between shapes. VME and kinematics were analyzed with two-way repeated measures ANOVA and pairwise post-hoc between group comparisons.

Results
Compared to controls, the AIM group demonstrated improvement in VME maximum (AIM=888, CON=7211, p= 0.001) and the number of joints differentiated at object contact (AIM =61, CON=21, p=0.012), indicating better shaping while receiving alternating input from the less affected hand. No improvement was noted in VME at deceleration prior to object contact in either group. Gains in the number of joints differentiated were maintained at post-testing (AIM=51, CON=41, p=0.005).

Conclusion
Findings of improved hand-shaping at the end of the movement support proof-of-concept that subjects can use AIM training to utilize information from the less-affected hand to inform hand-shaping in the affected hand. This approach may be a useful paradigm to increase grasp control in children with USCP.


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