Peer-reviewed article

Bimanual coordination in children with unilateral cerebral palsy: Effects of short- and intensive bimanual training on spatiotemporal characteristics.

Gardas SS, Willson J, Surkar SM · 29 Aug 2026

Abstract

Objectives This study aimed to compare the effects of short versus intensive bimanual training on spatiotemporal characteristics of bimanual coordination in children with unilateral cerebral palsy (UCP). Methods In a prospective, repeated-measures design, 28 children with UCP completed two training regimens: a short dose (75 repetitions of speed stacking; ∼1-1.5 h) and an intensive dose (30 h of Hand arm bimanual intensive training). Bimanual movement time was indexed by average time to complete nine trials of cup-stacking representing bimanual learning. Spatiotemporal kinematics were evaluated using three-dimensional motion analysis. For the bimanual coordination (stacking 6 cups) task, outcomes included normalized movement overlap, total task duration, and participation time. For a symmetric bimanual task (simultaneous two-cup transfer), task synchronization and completion time were analyzed. Peak tangential velocity and hand trajectory were assessed across both tasks. General linear models with repeated measures were used to analyze the effects of training dose and extremity. Results There was a significant main effect of training dose on movement time (p < 0.001), with both doses indicating improved bimanual learning. The intensive dose yielded significantly greater gains in normalized movement overlap, total task duration, hand trajectory, and participation time (all p = 0.001) during the bimanual coordination task. A dose-by-extremity interaction was identified for peak tangential velocity (p = 0.03), demonstrating greater velocity gains in the more affected limb. In the symmetric task, a main effect of dose was found only for hand trajectory (p < 0.03). Conclusions Both short and intensive bimanual training enhanced bimanual movement time reflecting bimanual learning and coordination in children with UCP. While intensive training yielded greater improvements, even brief, ecologically valid tasks produced measurable gains, highlighting the importance of training intensity and task specificity in pediatric neurorehabilitation.