Bimanual Training Versus Unilateral Task Specific Training in Children With Spastic Hemiplegic Cerebral Palsy

NCT07437274 | Recruiting DMC

• 1 other identifier: UOL/IREB/25/15/03/13
• Study Type: interventional
• Target: 46
• Locations: 1 country
• Sites: 1

Brief Summary

Cerebral palsy is one of the most common childhood neurological disorders and often results in weakness, poor coordination, and stiffness (spasticity) in one side of the body in children with spastic hemiplegic cerebral palsy. These difficulties can significantly affect a child's ability to perform daily activities such as dressing, eating, playing, and school-related tasks. Upper limb rehabilitation plays a crucial role in improving independence and quality of life in these children. Two commonly used rehabilitation approaches are bimanual training, which focuses on using both hands together during functional tasks, and unilateral task-specific training, which focuses intensively on improving the affected hand through repetitive, goal-directed activities. Although both approaches are widely practiced in pediatric neurorehabilitation, there is limited direct comparison of their effectiveness in reducing spasticity and improving functional independence among children with spastic hemiplegic cerebral palsy, particularly in the local population of Pakistan. This randomized controlled trial aims to compare the effectiveness of bimanual training versus unilateral task-specific training in children aged 5-12 years diagnosed with spastic hemiplegic cerebral palsy. A total of 46 participants will be randomly assigned to one of two intervention groups. Both groups will receive therapy three times per week for eight weeks. Spasticity will be measured using the Modified Ashworth Scale (MAS), and functional independence will be assessed using the Pediatric Evaluation of Disability Inventory (PEDI). Assessments will be conducted before and after the intervention period. The results of this study may help clinicians, caregivers, and rehabilitation centers determine which therapy approach is more effective in improving upper limb function and independence in children with spastic hemiplegic cerebral palsy. Participation in this study is voluntary, and children may withdraw at any time without affecting their standard care.

Conditions

Spastic Cerebral Palsy (sCP)

Keywords

Bimanual Training; Unilateral Task-Specific Training; Pediatric Neurorehabilitation; Functional Independence

Outcome Measures

Primary Outcomes (1)

• Change in Upper Limb Spasticity Measured by Modified Ashworth Scale (MAS)

  Spasticity will be assessed using the Modified Ashworth Scale (MAS), a standardized clinical tool used to measure velocity-dependent resistance to passive muscle stretch. The MAS grades muscle tone on a scale from 0 to 4, with higher scores indicating greater spasticity. Upper limb muscle groups (including elbow flexors, wrist flexors, and finger flexors) will be evaluated by trained physiotherapists. The primary outcome will be the change in MAS score from baseline to post-intervention, comparing the effectiveness of bimanual training versus unilateral task-specific training in reducing spasticity.

  Baseline (Week 0) mid week(4), Post-intervention (Week 8)

Study Arms (2)

group A Bimanual Training Group

EXPERIMENTAL

Participants in this group will receive structured bimanual training designed to improve coordination, reduce spasticity, and enhance functional use of both upper limbs. The intervention will be delivered three sessions per week for 8 weeks, with each session lasting 60 minutes. Activities will include repetitive, goal-directed bilateral tasks such as buttoning shirts, folding clothes, opening containers, building with blocks, and bimanual play activities. Each session will be divided into three 20-minute activity blocks with 5-minute rest intervals to prevent fatigue. All sessions will be supervised by a certified pediatric physiotherapist trained in neurorehabilitation. In addition, participants will receive standardized baseline physiotherapy education at the start of the study.

Behavioral: Bimanual Training

group B Unilateral Task-Specific Training Group

ACTIVE COMPARATOR

Participants in this group will receive unilateral task-specific training focused on intensive use of the affected upper limb to promote neuroplasticity and functional recovery. The intervention will be delivered three sessions per week for 8 weeks, with each session lasting 60 minutes. Activities will include grasp-and-release exercises, reaching, stacking, drawing, flipping cards, and manipulation of objects using the affected hand. The unaffected hand may be mildly restrained when necessary to encourage active use of the affected limb without causing frustration. Sessions will be structured into three 20-minute blocks with 5-minute rest intervals. Standardized baseline physiotherapy education will also be provided at the beginning of the study.

Behavioral: Unilateral Task-Specific Training

Interventions

Bimanual Training BEHAVIORAL

Bimanual training is a structured, task-oriented upper limb rehabilitation program designed to promote coordinated use of both hands during functional, goal-directed activities. The intervention emphasizes active involvement of the affected upper limb within bilateral tasks rather than isolating it. Therapy will be delivered three sessions per week for 8 weeks, with each session lasting 60 minutes. Each session will consist of three 20-minute activity blocks with 5-minute rest intervals to reduce fatigue. Activities will include age-appropriate, real-life bilateral tasks such as buttoning shirts, folding clothes, opening containers, building with blocks, drawing with both hands, catching and throwing balls, and interactive bimanual play tasks. Task complexity will be progressively increased based on the child's tolerance and performance. Unlike unilateral training, this approach focuses on improving interlimb coordination, motor planning, and functional integration of both upper limb

group A Bimanual Training Group

Unilateral Task-Specific Training BEHAVIORAL

Unilateral Task-Specific Training

group B Unilateral Task-Specific Training Group

Eligibility Criteria

• Age: 5 Years - 15 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17)

You may qualify if:

• Both male and female Children diagnosed with spastic hemiplegic cerebral palsy (confirmed by a pediatric neurologist or rehabilitation specialist).
• Age range: 5 to 12 years (suitable for both bimanual and unilateral task-specific training).
• Gross Motor Function Classification System (GMFCS) levels I to III (ambulatory with or without limitations).
• Modified Ashworth Scale score between 1 and 3 in the upper limb muscles (indicating mild to moderate spasticity).
• Minimum cognitive ability to follow simple instructions, verified using screening tools (e.g., MMSE adapted for children).
• Ability to sit unsupported for at least 30 seconds (to ensure safe participation in therapy).

You may not qualify if:

• Children with mixed types of cerebral palsy (e.g., spastic quadriplegia, dyskinetic, or ataxic types).
• Recent orthopedic surgery or botulinum toxin injections in the affected upper limb within the past 6 months.
• Severe visual, auditory, or sensory deficits that could interfere with therapy participation or assessment accuracy.
• Uncontrolled epilepsy or other neurological conditions that could compromise safety during therapy.
• Fixed joint contractures or severe deformities in the upper limbs that limit passive range of motion Children with behavioral or psychological disorders (e.g., severe ADHD, autism spectrum disorder) that impair attention or participation

Sponsors & Collaborators

• Montiha Azeem: lead

Study Sites (1)

University of Lahore Teaching Hospital, Lahore

Lahore, Punjab Province, 54000, Pakistan

RECRUITING

MeSH Terms

Conditions

Cerebral Palsy

Condition Hierarchy (Ancestors)

Brain Damage, Chronic; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases

Study Officials

• Muhammad Hasnain Soomro, MSPTN

  The University of Lahore, Lahore

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Muhammad Hasnain Soomro, MSPTN

CONTACT

03158463003; drhasnainsoomro@gmail.com

Montiha Azeem, MSPTN

CONTACT

03479717317; muntahaazeem9@gmail.com

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR INVESTIGATOR
• PI Title: principal investigator

Study Record Dates

• First Submitted: February 20, 2026
• First Posted: February 27, 2026
• Study Start: March 1, 2026
• Primary Completion: March 1, 2026
• Study Completion: May 2, 2026
• Last Updated: March 9, 2026

Record last verified: 2026-02

Locations

PA (1)