Combining constraint-induced movement therapy and action-observation training in children with unilateral cerebral palsy: a randomized controlled trial

Abstract

BackgroundUpper limb (UL) deficits in children with unilateral cerebral palsy (uCP) have traditionally been targeted with motor execution treatment models, such as modified Constraint-Induced Movement Therapy (mCIMT). However, new approaches based on a neurophysiological model such as Action-Observation Training (AOT) may provide new opportunities for enhanced motor learning. The aim of this study is to describe a randomised controlled trial (RCT) protocol investigating the effects of an intensive treatment model, combining mCIMT and AOT compared to mCIMT alone on UL function in children with uCP. Additionally, the role of neurological factors as potential biomarkers of treatment response will be analysed.MethodsAn evaluator-blinded RCT will be conducted in 42 children aged between 6 and 12 years. Before randomization, children will be stratified according to their House Functional Classification Scale, age and type of corticospinal tract wiring. A 2-week day-camp will be set up in which children receive intensive mCIMT therapy for 6 hours a day on 9 out of 11 consecutive days (54 h) including AOT or control condition (15 h). During AOT, these children watch video sequences showing goal-directed actions and subsequently execute the observed actions with the more impaired UL. The control group performs the same actions after watching computer games without human motion. The primary outcome measure will be the Assisting Hand Assessment. Secondary outcomes comprise clinical assessments across body function, activity and participation level of the International Classification of Function, Disability and Health. Furthermore, to quantitatively evaluate UL movement patterns, a three-dimensional motion analysis will be conducted. UL function will be assessed at baseline, immediately before and after intervention and at 6 months follow up. Brain imaging comprising structural and functional connectivity measures as well as Transcranial Magnetic Stimulation (TMS) to evaluate corticospinal tract wiring will be acquired before the intervention.DiscussionThis paper describes the methodology of an RCT with two main objectives: (1) to evaluate the added value of AOT to mCIMT on UL outcome in children with uCP and (2) to investigate the role of neurological factors as potential biomarkers of treatment response.Trial registrationNCT03256357 registered on 21st August 2017 (retrospectively registered).Electronic supplementary materialThe online version of this article (10.1186/s12887-018-1228-2) contains supplementary material, which is available to authorized users.

Effects of combining constraint-induced movement therapy and action-observation training on upper limb kinematics in children with unilateral cerebral palsy: A randomized controlled trial

“…The evaluation consisted of an UL-3DMA, based on a protocol specially developed for children with uCP 21,22 . The protocol has shown to be reliable and valid, and full protocol details can be found elsewhere 21,42 . Seventeen reflective markers were mounted on the trunk, acromion, upper arm, forearm and hand to record UL motion with 12-15 Vicon infrared cameras (Oxford Metrics, Oxford, UK) sampling at 100 Hz.…”

Randomized controlled trial combining constraint-induced movement therapy and action-observation training in unilateral cerebral palsy: clinical effects and influencing factors of treatment response

“…The description of the activities can be found in more detail elsewhere ( Figure 1 and Additional files of Simon-Martinez and colleagues). 16 Each AOT session lasted about 1 h and 15 AOT sessions were performed over 9 days (either 1 or 2 per day). Each AOT session contained 3 sub-activities, which were watched for 3 min.…”

The Most Cited Original Articles in Brain Imaging of Children With Cerebral Palsy: A Bibliometric Analysis Between 1984 and 2019

“…The utilization of imaging modality changed from single modality evaluation (30,31) to multi-modality evaluation combined with a functional modality such as TMS (32). The treatments evaluated have also changed from single treatment efficacy evaluation (30,31) to multiple treatment efficacy evaluation, accompanied by the development of possible treatment-specific biomarkers (33). Thus, we can conclude that the use of brain imaging techniques to evaluate therapeutic effect has become the current research focus and can lead the direction of future study.…”

“…Results: A total of 50 highly cited articles ranked by yearly citations (from 23.85 to 3. 33, were included in this study. Considering different research purposes, these studies were classified into three categories: diagnosis studies (n = 25; 1991-2017, median: 2011), mechanism studies (n = 15; 1999-2018; median: 2014), and prognosis and therapeutic effect studies (n = 10; 2008-2017; median: 2014.5).…”