Effectiveness of hand-arm bimanual intensive therapy in neurological training: a comprehensive scientific literature review

Abstract

Hand-arm bimanual intensive therapy (HABIT) is an intensive rehabilitation approach designed to improve bimanual coordination and functional hand use in individuals with neurological impairments. Unlike constraint-induced movement therapy, HABIT emphasizes simultaneous bilateral practice of meaningful tasks, leveraging neuroplasticity principles to drive functional recovery. This scoping review synthesizes evidence from eight randomized controlled trials and high-quality protocols to evaluate the effectiveness, feasibility and innovations in HABIT and HABIT including lower extremities (HABIT-ILE) across cerebral palsy and stroke populations. A multi-phase search strategy was conducted across PubMed, Google Scholar and SciSpace, yielding 177 unique records. After screening and eligibility assessment, eight studies were included. Methodological quality and risk of bias was appraised and summarised. In unilateral cerebral palsy, HABIT consistently improved assisting hand assessment (AHA) scores, dexterity and caregiver-reported outcomes, with stronger effects observed in early interventions. HABIT-ILE demonstrated additional benefits for lower extremity function without compromising upper limb gains. In bilateral cerebral palsy, HABIT improved dialy functioning and dominant-hand dexterity, while large multisite trials confirmed feasibility across a wide severity spectrum. In stroke populations, HABIT delivered in the acute phase produces superior motor recovery compared to conventional rehabilitation, supporting its adaptability beyond paediatric contexts. Home-based HABIT models showed promise for dexterity and goal attainment, though bimanual performance gains were less robust. HABIT demonstrate consistent efficacy in enhancing functional outcomes across cerebral palsy and stroke, with early intensive delivery yielding the most clinically meaningful improvements. Evidence supports HABIT as a scalable, neuroplasticity-driven intervention, though heterogeneity in dosage, delivery models and outcome measures underscores the need for standardized protocols and exploration of adjunctive innovations such as neuromodulation and virtual reality.