A magic-themed approach to intensive upper-limb therapy for children with unilateral cerebral palsy

Abstract

Unilateral cerebral palsy (CP) is associated with movement difficulties, spasticity, weakness, and sensory dysfunction, which are mainly lateralised to one side of the body. Children with unilateral CP experience limitations in bimanual coordination, and difficulties completing everyday bimanual tasks. An intensive bimanual therapy, ‘hand-arm bimanual intensive therapy’ (HABIT), incorporates motor learning theory to improve bimanual hand use. Amazing Magic Club (AMC) incorporating HABIT, supports children to learn magic tricks and performance skills over two intensive weeks. We conducted a single group pre-post study with 28 children with unilateral CP. The aims of this study were to explore upper limb function, occupational performance, parent report of hand use, psychosocial outcomes and parents’ perceptions. Endpoints were, immediately after, 3 months and 6 months after, AMC. Occupational performance improved after AMC, and at follow-up time points. Parent report of bimanual tasks and unimanual skills also improved, although there were no changes in standardised measurement of bimanual performance. We measured psychosocial outcomes, following anecdotal reports from previous research of the potential impact of AMC on these outcomes. Half of our child participants were identified as ‘at risk’ before AMC began; and half of these children experienced psychosocial gains that were not related to improvements in bimanual performance. We completed interviews with parents immediately after AMC to explore features of AMC that may have contributed to improvements in occupational performance and psychosocial change for some children. AMC appeared to capture intrinsic motivation for children to persist with challenging tasks. AMC offered potential to satisfy the needs of self-determination theory; incorporating opportunities for shared learning, developing competence in a valued skill and with an autonomous approach to everyday activities.