Efficacy of Hand Arm Bimanual Intensive Therapy in Improving Real-World Bimanual Performance and Identifying Predictors for Therapy Success in Children with Unilateral Cerebral Palsy

This study assesses real-world bimanual performance improvements following Hand-Arm Bimanual Intensive Therapy (HABIT) using an objective tool (accelerometers) and to identify demographic and clinical predictors of these gains in children with unilateral cerebral palsy (UCP). Forty children with UCP (mean age: 10.7 ± 3.24 years) participated in 30 h of HABIT. Bilateral wrist-worn accelerometers measured bimanual performance using use ratio, bilateral magnitude, and median acceleration. Self-perceived performance was measured using the Canadian Occupational Performance Measure (COPM), and upper extremity (UE) capacity with Jebsen-Taylor Hand Function Test (JTHFT), Nine-Hole Peg Test (NHPT), and Box and Block Test (BBT). Predictors such as age, sex, affected side, severity levels, and baseline capacity were analyzed. Use ratio (<i>p</i> = .02) and median acceleration (<i>p</i> = .04) showed improvements, indicating enhanced real-world performance. Gains were observed in COPM (performance and satisfaction, <i>p</i> = .001) and UE capacity (JTHFT: <i>p</i> = .001, NHPT: <i>p</i> = .02, and BBT: <i>p</i> = .01). Age, baseline NHPT and JTHFT scores explained 40.7% of the variance in use ratio, while NHPT accounted for 11.5% of the variance in median acceleration. HABIT enhances real-world bimanual performance in children with UCP. Older age and more impaired baseline dexterity are significant predictors of greater therapeutic gains, offering potential strategy to maximize real-world functional gains.