Constraint-induced movement therapy in the treatment of the upper limb in children with hemiplegic cerebral palsy

Abstract

This systematic review found a significant treatment effect using modified CIMT in a single trial. A positive trend favouring CIMT and Forced Use was also demonstrated. 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 and reliable outcome measures is essential to provide higher level support of the effectiveness of CIMT for children with hemiplegic cerebral palsy.

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

“…It measures only one aspect of spasticity and it's administration takes less than 5 minutes [5]. 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].…”

The Cerebral Palsy Kinematic Assessment Tool (CPKAT): feasibility testing of a new portable tool for the objective evaluation of upper limb kinematics in children with cerebral palsy in the non-laboratory setting

“…The impact of therapy type, frequency and intensity is poorly researched with studies into upper limb rehabilitation showing a wide variety of prescribed approaches [21][22][23] . An objective measure of upper limb kinematics might detect the presence of reliable but subtle improvements that are not sufficiently large to be captured by functional measures.…”

Unravelling the cerebral palsy upper limb

“…One uni-manual approach, constraint-induced movement therapy (CIMT), is gaining popularity amongst clinicians despite the limited evidence for its efficacy. 1 The CIMT studies published to date have seen large inter-individual differences in response to treatment and in 2007 a systematic review reported it was not yet possible to accurately define the individual characteristics of children who would benefit from CIMT. 1 Previous trials have provided evidence that response to CIMT was not age-dependent and children with poorer bimanual hand function improved more than the more capable ones.…”

“…1 The CIMT studies published to date have seen large inter-individual differences in response to treatment and in 2007 a systematic review reported it was not yet possible to accurately define the individual characteristics of children who would benefit from CIMT. 1 Previous trials have provided evidence that response to CIMT was not age-dependent and children with poorer bimanual hand function improved more than the more capable ones. Although not statistically significant, trends have also been reported as favouring children with cortical ⁄ subcortical lesions compared to those with periventricular white matter lesions.…”

“…Although not statistically significant, trends have also been reported as favouring children with cortical ⁄ subcortical lesions compared to those with periventricular white matter lesions. 1 In this issue, the paper by Kuhnke et al exploring the impact of different types of corticospinal (re)organization on CIMT outcomes, adds important information about children's responses to uni-manual upper limb intervention. This study is limited by the small sample size, broad age range, and uni-manual rather than bimanual outcome measure.…”