Bimanual training for children with cerebral palsy: Exploring the effects of Lissajous-based computer gaming

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Abstract
Objective: Hemiplegic cerebral palsy often results in impaired bimanual coordination, partly due to strong coupling between the arms. We aimed at inducing more flexibility in this coupling, to improve bimanual coordination. Methods: We designed computer games involving simple perceptual goals, based on Lissajous feedback. Such feedback implicitly facilitates the performance of complex rhythmic bimanual coordination patterns. A sample of six children received 9 h of computer training over a 6 weeks period. The effects of this training on functional bimanual performance were explored using the Assisting Hand Assessment (AHA). Results: Gaming performance and bimanual rhythmic antiphase coordination improved after training. The AHA results were mixed. Two children improved significantly, but at a group level no significant effects were found. Conclusions: The results were evaluated in relation to the specificity of the AHA and the potential benefit of combining the proposed training with dedicated bimanual functional training programs.

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