Developing a Bimanual Task-Oriented Training Program for Young Children With Unilateral Cerebral Palsy: A Delphi Consensus Study

Importance: Children with unilateral cerebral palsy (UCP) experience motor impairments that affect daily functioning. Despite clinical improvements with current therapies, evidence-based practices for home settings are lacking. Objective: To develop a tailored, task-specific, home-based upper limb training program for children with UCP using the Delphi method to bridge the gap between therapy and daily life improvements. Design: Three-phase design that involved identifying key tasks based on Canadian Occupational Performance Measure (COPM) data, developing pilot activities, and achieving expert consensus through Delphi rounds. Setting: Electronic survey. Participants: Sixty-five experts (30 occupational therapists, 30 physical therapists, and 5 pediatric physiatrists), with 55 participants continuing through the Delphi rounds. Outcomes and Measures: Participants rated their level of agreement with the proposed activities on a 10-point scale (1 5 strongly disagree, 10 5 strongly agree). Agreement was defined as ≥6 or higher, and disagreement as ≤5. A consensus was determined to have been reached if there was ≥70% agreement among panelists and a mean importance of ≥7. Results: The initial COPM results for 22 children with UCP identified self-care tasks as critical, with dressing, feeding, and hygiene as the highest priorities; thus, 110 preliminary therapeutic activities were developed and refined in a pilot study. The Delphi process yielded a consensus on 106 of the 122 proposed activities, resulting in a comprehensive set of task-specific activities. Conclusions and Relevance: This consensus-driven approach provides expert-supported therapeutic activities with the potential to be applied in real-world settings. Further research should incorporate stakeholder perspectives to validate these activities and assess their impact on outcomes for children with UCP. Plain-Language Summary: There are ongoing questions regarding whether task-specific training can effectively enhance daily performance in children with unilateral cerebral palsy (UCP). To address this issue, we developed a task-oriented training program with input from pediatric therapy experts. This program emphasizes essential self-care tasks, such as dressing, feeding, and hygiene. Through a consensus reached using Delphi rounds, 106 activities were created to help children practice and enhance their skills at home. These activities are intended to make daily tasks easier and improve children’s independence. This program provides occupational therapists with a structured framework for implementing task-oriented interventions in real-world settings. Further research is necessary to assess the impact of these activities on improving the outcomes of children with UCP.