Effects of an HABIT-ILE-Based Intervention in Children With Cerebral Palsy

Children with cerebral palsy frequently present limitations in upper and lower extremity function that affect mobility, daily activities, and participation. Intensive motor control-based approaches, particularly Hand-Arm Bimanual Intensive Therapy (HABIT) and Hand-Arm Bimanual Intensive Therapy Including Lower Extremity (HABIT-ILE), have shown functional benefits in this population. In prior HABIT/HABIT-ILE programs, improvements in upper limb function have been reported, and benefits may persist over time after the intervention. In addition to motor impairment, children with cerebral palsy may be especially vulnerable to sedentary behavior and related health consequences. The present study is based on the rationale that intensive whole-body functional training may improve not only motor performance but also physiological efficiency during functional tasks. The main novelty of this study is not the intervention format itself, but the evaluation of task-related energy expenditure and post-intervention body composition changes after an intensive HABIT-ILE-based summer camp.This study will implement a summer camp-format intensive intervention in children with cerebral palsy, modeled on previously implemented intensive camp experiences. Participants will receive 90 hours of therapy over 15 days (6 hours/day), delivered by trained interventionists (physiotherapists, occupational therapists, supervised students, and volunteers under professional supervision). The intervention will include bimanual upper limb activities; lower extremity and mobility training (e.g., walking on different surfaces, treadmill walking, stair negotiation); functional strengthening through activity-based tasks; and whole-body playful activities (e.g., dance and sports games), with progressive difficulty tailored to each child's performance. Activities will be delivered in small groups (approximately 4-6 children) to promote motivation and peer interaction, and the program will be organized to prevent excessive fatigue.Outcome assessments will include functional measures for upper and lower extremity performance and parent-/tutor-reported functional perception. The protocol also includes low-intensity task-related energy expenditure assessment using physiological monitoring (gas analysis and electrocardiographic monitoring during functional tasks such as comfortable walking) in the physiology laboratory, and body composition assessment using DEXA at Universidad Europea de Madrid. Assessments will be performed at baseline and immediately after the camp in July 2027, with follow-up assessments at 6 months (January 2028). To improve measurement consistency, pre/post testing will be performed by the same evaluator, and test sessions may be recorded for review; the evaluator is intended to be blinded to the intervention.

Inclusion criteria

• Children with a diagnosis of cerebral palsy (hemiparesis or diparesis).
• Age 6 to 13 years.
• Moderate cognitive impairment or cognitive status compatible with the ability to follow verbal instructions.
• Ability to participate in an intensive summer camp-format rehabilitation program.
• Parent/legal guardian able to provide informed consent and complete parent-/tutor-reported outcome measures.

Exclusion criteria

• Medical or orthopedic condition that contraindicates participation in intensive physical rehabilitation activities.
• Unstable neurological or medical condition (e.g., uncontrolled seizures) that may interfere with safe participation.
• Severe cognitive or behavioral impairment preventing comprehension of basic verbal instructions or safe participation in group activities.
• Contraindication to study assessment procedures, including physiological testing or DEXA body composition assessment.
• Participation in another concurrent intensive rehabilitation program during the study comparison period.
• Any condition that, in the investigators' judgment, may compromise safety, adherence, or outcome assessment validity.