Constraint-induced movement therapy in the treatment of the upper limb in children with hemiplegic cerebral palsy: a Cochrane systematic review

Abstract

Given the limited evidence, the use of CIMT, modified CIMT and Forced use should be considered experimental in children with hemiplegic cerebral palsy. Further research using adequately powered RCTs, rigorous methodology and valid, reliable outcome measures is essential to provide higher level support of the effectiveness of CIMT for children with hemiplegic cerebral palsy.

Effectiveness of physical therapy interventions for children with cerebral palsy: a systematic review

“…In another trial, prehensile hand treatment with NDT or NDT provided twice a week improved the children's developmental status as compared to NDT once a week [43] Secondly, constraintinduced therapy resulted in better functional use of the spastic upper extremity compared to conventional therapy [52,53]. Similar conclusions were made in a recent Cochrane review [22].…”

“…These systematic reviews covered various study designs, with only a few assessing the study quality, and only 12 randomized controlled trials (RCTs) were identified between 1973 and 1998. More recent systematic review topics included focused interventions, such as constrained-induced movement therapy [22], postural control [23], passive stretching [24], hydrotherapy [25], hippotherapy [26,27], and orthotic devices [28]. Overall, the effectiveness and efficacy of therapeutic interventions for children with CP has been difficult to determine owing to the lack of high-quality research.…”

Constraint Induced Movement Therapy and Real-World Arm Use in Children With Hemiparesis

“…Children frequently used only their unaffected upper extremity to increase the efficiency of performing tasks, which is known as developmental disregard. These problems further limited daily activities and participation of children with unilateral CP [7].Constraint induced movement therapy was the choice of treatment in present study as it constrained the unaffected upper extremity which prevented children from performing daily tasks with unaffected upper extremity leading to developmental disregard instead CIMT forced children with hemiparesis to perform ADL with affected extremity where the results showed positive improvement in functional arm hand movement which came in agreement with the study of that described CIMT as an efficacious in producing improvements in use of a more-affected upper extremity after central nervous system damage in adults. Using the same basic method, more improvements have been demonstrated in young children with CP [20].…”

“…Children with hemiplegic CP often compensate for their weak arm by choosing to perform most tasks with their unaffected arm this leaded to developmental disregard or learned non-use where the affected limb is further inhibited from healthy development [6]. Constraint induced movement therapy(CIMT) is used in children with spastic hemiparesis [7]. Some studies have yielded positive outcomes for all participants who receive CIMT [8].…”

Feasibility of school-based computer-assisted robotic gaming technology for upper limb rehabilitation of children with cerebral palsy

“…For example, Constraint Induced Movement Therapy (CIMT) is an experimental approach 11 to supplement therapy programmes by constraining the affected limb, encouraging increased and more intensive practice of useful activities. CIMT has produced promising results in small trials 11,12 . Similarly, the potential for the use of robots to support repetitive motor training as an adjunct to therapy-supported programmes for motor rehabilitation 13 has provided impetus into the use of robotic assistive technology to supplement exercise programmes of children with cerebral palsy through assisted repetitive reaching 14,15 .…”