Mirror Movements In Unilateral Spastic Cerebral Palsy: Effects Of A Goal-Oriented Bimanual Therapy

Background: Many children with unilateral spastic cerebral palsy (USCP) show involuntary movements of one hand during voluntary unimanual movement with the other hand, so-called mirror movements (MM). These MM make bimanual activities of daily living (ADL) more difficult.¹ We therefore developed a therapy program especially for children with this problem.

Methods: A total of 11 children and adolescents (age range, 6–17 years) with USCP and MM received 3 weeks of intensive training in an inpatient setting. All training components were strictly bimanual focusing on independent (simultaneous and asymmetric) movements of the two hands. Training comprised functional exercises and bimanual ADLs.

Results: Improvements were documented in the Goal Attainment Scale (which included exclusively bimanual goal activities requiring asymmetric hand use: Change Score >20 in 9/11 participants), in the unimanual capacity of the paretic hand (Jebson Taylor: improvement  > 20% in 6/11 participants), and in bimanual performance (AHA: improvement ≥ 5 units in 4/11 participants). Self-assessment of the trained ADLs improved in terms of performance (3 → 8) as well as in satisfaction (4 → 8; scale 1–10).

Surprisingly, we detected no changes in a standardized observation of MM² nor in a quantified measure of MM during an untrained test condition (unimanual holding of an object while repetitively squeezing a rubber ball with the other hand; similar to the study by Kuhtz–Buschbeck et al³).

Conclusion: Goal-oriented therapy for children and adolescents with USCP and MM improved unimanual capacity and the bimanual execution of ADLs especially for the trained asymmetric-bimanual goal activities. Here, participants apparently learned to control their MM voluntarily, whereas in an untrained artificial test situation, no reduction of MM could be observed.

References

References

1 Adler C, Berweck S, Lidzba K, Becher T, Staudt M. Mirror movements in unilateral spastic cerebral palsy: Specific negative impact on bimanual activities of daily living. Eur J Paediatr Neurol 2015;19:504–509

2 Woods BT, Teuber HL. Mirror movements after childhood hemiparesis. Neurology 1978;28:1152–1158

3 Kuhtz-Buschbeck JP, Krumlinde-Sundholm L, Eliasson AC, Forssberg H. Quantitative assessment of mirror movements in children and adolescents with hemiplegic cerebral palsy. Dev Med Child Neurol 2000;42:728–736