Hand-Arm Bimanual Intensive Training (HABIT)

Hand-Arm Bimanual Intensive Therapy (HABIT) is an intervention developed at Columbia University to improve the coordinated use of both hands and arms in children with hemiplegia. HABIT is designed to strengthen bimanual function in everyday activities through intensive, structured practice in a fun, group-based setting.

Like Constraint-Induced Movement Therapy (CIMT), HABIT involves 90 hours of intensive therapy. However, while CIMT focuses primarily on improving use of the affected arm, HABIT specifically targets the ability to perform activities that require both hands working together. Research to date has shown promising results, with studies demonstrating that HABIT can effectively improve bimanual coordination and functional hand use. These findings also support the idea that successful hand rehabilitation does not depend on restraining the unaffected hand.

This work builds on earlier research from our laboratory examining hand function in children with hemiplegic cerebral palsy. In those studies, we found that children with hemiplegia often show less synchronized and more sequential patterns of bimanual coordination than typically developing children.

Although CIMT has been shown to be effective for many children with cerebral palsy, it may not be equally beneficial for all children, particularly those with either very mild or more severe hand impairments. In addition, while CIMT may improve use of the affected hand, it is less clear how well those gains translate to everyday tasks that require coordinated use of both hands. HABIT was developed in response to these questions and to explore whether intensive bimanual practice could serve as an effective, child-friendly alternative or complement to CIMT.

Supported by funding from the Thrasher Research Foundation, we have studied HABIT in more than 100 children to date. Our findings have shown substantial promise, including similar overall effectiveness to CIMT across many clinical outcomes. In some areas, HABIT may offer particular advantages, especially in helping children make progress toward goals identified as important by both children and their caregivers.

Children with unilateral cerebral palsy often experience challenges with hand function as a result of early brain injury. There is a critical need for effective, evidence-based therapies to improve hand use and daily function. Our current project for children with hemiplegia brings together experts in clinical neurorehabilitation, brain imaging, and biomedical engineering to evaluate a promising new treatment approach for children with cerebral palsy.

The study examines skilled bimanual therapy combined with transcranial direct-current stimulation (tDCS), a non-invasive form of brain stimulation that may enhance motor learning. Our goal is to better understand how brain stimulation and motor training can be combined to support rehabilitation most effectively. If successful, this approach could help reduce the time demands of intensive therapy while improving outcomes for children with cerebral palsy. The findings may also have broader implications for rehabilitation in other neurological conditions, including stroke and spinal cord injury.

More information here: Bimanual Training and Transcranial Direct Current Stimulation (tDCS)