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Presentation date

Summer 8-10-2023

College, Institute, or Department

Munroe Meyer Institute

Faculty Mentor

Andrea Baraldi Cunha

Research Mentor

Andrea Baraldi Cunha


Purpose/ Hypothesis: The purpose of this study was to behaviorally code participants’ behaviors of a Hand Arm Bimanual Intensive Training (HABIT) camp. It was hypothesized the HABIT program would implement high levels of motor and social behaviors using behavioral coding as a measurement of fidelity.

Number of Subjects: Five children (Mean age=8.8 years, SD=1.6 years), three females, diagnosed with unilateral cerebral palsy (CP), right-side impairment. Participants were classified as Manual Ability Classification System (MACS) levels I-III.

Materials and Methods: The HABIT camp took place over a two-week period, ten days of intervention, four hours daily for a total of 40 hours. Oversight of daily intervention was directed by two therapists assisted by seven volunteers trained on HABIT key principles. A fidelity measurement was implemented to establish if participant behaviors were congruent with the intervention principles of HABIT through behavioral coding. Video footage was collected at random intervals throughout the intervention to measure the following behaviors’ duration: right/left contact, right/left object manipulation, tasks [i.e., therapist-provided activities that either do (complex tasks) or do not (simple tasks) cognitively challenge the subject], social engagement with peers, and focused attention (i.e., when subject focuses on an object while object exploration occurs). This preliminary report contains three random videos per participant, averaging approximately 30 minutes per video (total of 6.75 hours). Datavyu software was used to code behaviors [interrater reliability =85.4% 8.6]. The variables were summed as durations and normalized as percentages.

Results: On average, the percentage of the duration of contacts was relatively equal between left (M= 63.8, SD=11.7) and right (M=46.1, SD=12.5) hands. The percent of the duration of object manipulation varied between the left (M=20.0, SD=10.9) and right (M=5.7, SD=5.8) hands. Children were engaged in simple tasks (e.g., playing with play dough) (M=34.9, SD=12.4) more often than complex tasks (e.g., target game) (M=20.7, SD=12.8), but varied by participant. Children were socially engaged with their peers (M=51.0, SD=12.9), alongside focused on an object while exploring it (M=34.8, SD=13.3).

Conclusions: Both hands performed a similar duration of contact. Manipulations differed greatly between hands, favoring the unaffected left hand. It may be due to MACS classification systems and the use of their affected hand primarily for support. Simple tasks were performed more often than complex tasks, and social engagement with peers occurred most of the time. Clinical Relevance: This preliminary report of the 2022 HABIT camp suggests the intervention accomplishes its established high-intensity and engagement principles of intervention but may be limited to meeting challenging task goals. This study adds to existing research testing HABIT’s methodological approach to physical therapy intervention and to fidelity use in clinical settings relating to HABIT programming.


intervention, fidelity, HABIT

Preliminary Assessment of HABIT for Children with Unilateral Cerebral Palsy Using Fidelity Measures