Application of Low-Intensity Modified Constraint-Induced Movement Therapy to Improve the Affected Upper Limb Functionality in Infantile Hemiplegia with Moderate Manual Ability: Case Series

Abstract

Objective: To assess the functionality of the affected upper limb in children diagnosed with hemiplegia aged between 4 and 8 years after applying low-intensity modified Constraint-Induced Movement Therapy (mCIMT). Methods: Prospective case series study. A mCIMT protocol was applied for five weeks, with two hours of containment per day. The study variables were quality of movement of the upper limb, spontaneous use, participation of the affected upper limb in activities of daily living, dynamic joint position, grasp–release action, grasp strength, supination and extension elbow movements. Four measurements were performed, using the quality of upper extremity test (QUEST) scale, the Shriners Hospital for Children Upper Extremity Evaluation (SHUEE) Evaluation, a hand dynamometer and a goniometer. Results: The sample was composed of eight children with moderate manual ability. Statistically significant differences were detected in all the studied variables (p < 0.05) between the pre-treatment and post–treatment results (Week 0–Week 5), except for upper limb dressing, putting on splints and buttoning up. In the first week, the changes were statistically significant, except for protective extension, grasp strength, grasp–release and all functional variables (level of functionality and participation of the patient’s upper limbs) in the SHUEE Evaluation (p > 0.05). The greatest increase occurred in spontaneous use from Assessment 1 to Assessment 4 (p = 0.01), reaching 88.87% active participation in bimanual tasks. The quality of movement of the upper limb exhibited a significant value due to the increase in dissociated movements and grasp (p = 0.01). Conclusion: A low dose (50 h) of mCIMT increased the functionality of children diagnosed with congenital hemiplegia between 4 and 8 years of age with moderate manual ability.

Can the Shriners Hospital Upper Extremity Evaluation (SHUEE) Detect Change in Dynamic Position and Spontaneous Function of the Upper Limb in People With Hemiplegic Cerebral Palsy?

“…Other interventions, such as CIMT and hand-arm bimanual intensive training, are intended to improve use of the affected limb and are quickly becoming standard therapy care in people with hemiplegic CP 8. Multiple researchers have examined these interventions in people with CP and found significant improvements in SHUEE SFA score as well as several other motor activity measures 6–8,20–23.…”

“…8 Multiple researchers have examined these interventions in people with CP and found significant improvements in SHUEE SFA score as well as several other motor activity measures. [6][7][8][20][21][22][23] For people with hemiplegic CP, CIMT is a thoroughly studied noninvasive intervention that, in short-term regimens, achieves statistically significant improvements.…”

“…2,[9][10][11] Similarly, noninvasive options, such as therapies that stimulate use of the affected limb by constraining the unaffected hand, can improve use and coordination of the involved limb in children with hemiplegic CP. [6][7][8] The Shriners Hospital Upper Extremity Evaluation (SHUEE) is a video assessment tool used to evaluate the upper limbs of children with hemiplegic CP. 12 Dynamic positional analysis (DPA), an assessment of segmental alignment of the affected extremity (elbow, forearm, wrist, finger, and thumb), and spontaneous functional analysis (SFA), an evaluation of spontaneous use of the involved extremity, are scored based on the child's performance of a set of daily living tasks.…”

Modified Constraint-Induced Movement Therapy at Home—Is It Possible? Families and Children’s Experience

“…Thus, in this study, we aimed to collect the experiences of parents and their children (aged 4–8 years) who did mCIMT at home in the application of low-intensity (<3 h per day) modified constraint-induced movement therapy to improve the affected UL functionality in infantile hemiplegia with moderate manual ability [ 17 ].…”

Future Challenges in Research in Children with Neurodevelopmental Disorders

“…Regarding interventions, the effects of low-intensity modified Constraint-Induced Movement Therapy on upper limb functionality in eight children with hemiplegia aged 4–8 years are presented. The results of this study show an increase in the spontaneous use of the affected upper limb in bimanual tasks and dissociated and propensity movements [ 10 ]. Likewise, the study of Riquelme, Sabater-Gárriz and Montoya [ 11 ] delves into the impact on the family of chronic pain in children with cerebral palsy (CP) and its relationship to the quality of life of these children and their ability to communicate.…”