Effectiveness of Modified Constraint-Induced Movement Therapy in Children With Unilateral Spastic Cerebral Palsy: A Randomized Controlled Trial

Abstract

Background. In children with unilateral spastic cerebral palsy (CP), there is only limited evidence for the effectiveness of modified constraint-induced movement therapy (mCIMT). Objective. To investigate whether 6 weeks of mCIMT followed by 2 weeks of bimanual task-specific training (mCIMT-BiT) in children with unilateral spastic CP improves the spontaneous use of the affected limb in both qualitative and quantitative terms more than usual care (UC) of the same duration. Methods. Children with unilateral spastic CP with Manual Ability Classification System (MACS) scores I, II, or III and aged 2.5 to 8 years were recruited and randomly allocated to either the mCIMT-BiT group (three 3-hour sessions per week: 6 weeks of mCIMT, followed by 2 weeks of task-specific training in goal-directed bimanual play and self-care activities) or to 1.5 hours of more general physical or occupational weekly plus encouragement to use the affected hand for the UC group. Primary outcome measures were the Assisting Hand Assessment and the ABILHAND-Kids. Secondary outcomes were the Melbourne Assessment of Unilateral Upper Limb Function, the Canadian Occupational Performance Measure, and the Goal Attainment Scale. Results. Twenty-eight children were allocated to mCIMT-BiT and 24 to UC. Except for the Melbourne, all primary and secondary outcome measures demonstrated significant improvements in the mCIMT-BiT group. Conclusion. mCIMT followed by task-specific training of goal-directed bimanual play and self-care activities is an effective intervention to improve the spontaneous use of the more affected upper limb in children with relatively good baseline upper extremity function.

The influence of early modified constraint‐induced movement therapy training on the longitudinal development of hand function in children with unilateral cerebral palsy

“…1,2 The effect is maintained for at least 6 months after the therapy ends [3][4][5][6][7] and has been reported to last for up to 1 year. [8][9][10] Because the ultimate goal of treatment is to change the natural course of motor development in a lifetime perspective, it is important to investigate the long-term effect of mCIMT.…”

Constraint-induced movement therapy of upper limb of children with cerebral palsy in clinical practice: systematic review of the literature

“…CIMT was not employed in its classic form and was modified with respect to the constraint method, duration of constraint (days or weeks), type and duration of therapy, intervention setting (home, school or clinic) and intervention provider (therapist, parent or teacher). The first significant variant was the method employed to constrain the unaffected limb, for which a range of techniques was used, such as a mitt 21,22,[24][25][26]28 , sling [17][18][19][20] , cast 27 and splint…”

“…In two clinical trials conducted by Aarts et al 17,18 , the treatment group submitted to CIMT received more sessions per week and more hours per session than the control group, but the individuals in the control group complemented their training at home to match the total number of hours to which the treatment group was submitted. Choudhary et al 23 conducted interventions on ten days distributed over a four-week period, in which the treatment group received two hours per day at a rehabilitation center, and the control group received 20 minutes a day at home.…”

“…In 9 of the 12 clinical trials [17][18][19][20]22,23,[25][26][27] , difficulties and dropouts occurred due to family problems, scheduling problems, changes of address and a lack of transportation. In the study by Sakzewski et al 26 , nine of the participants dropped out of the study groups and a seizure occurred in one child during treatment; however, the authors did not describe the dropouts in detail.…”

“…For the functional classification of individuals eligible for inclusion in the study, the Manual Abilities Classification System (MACS) was used in two studies 17,18 , which was developed to categorize, respectively, the mobility and manual function of children with CP 31,32 . Other studies included in this review used the results of the Quality of Upper Extremity Skills Test (QUEST), Pediatric Motor Activity Log (PMAL) and Jebsen-Taylor Hand Function Test ( JTHF) as part of the inclusion criteria 19,[22][23][24] .…”