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

Abstract

Modified constraint-induced movement therapy (mCIMT) improves upper limb (UL) motor execution in unilateral cerebral palsy (uCP). As these children also show motor planning deficits, action-observation training (AOT) might be of additional value. Here, we investigated the combined value of AOT to mCIMT on UL kinematics in children with uCP. Thirty-six children with uCP completed an UL kinematic evaluation after participating in a 9-day mCIMT camp wearing a splint for 6 hours/day. The experimental group (mCIMT+AOT, n=20) received 15 hours of AOT, i.e. video-observation and execution of unimanual tasks. The control group (mCIMT+placebo, n=16) watched biological-motion free videos and executed the same tasks. We examined changes in motor control (movement duration, peak velocity, time-to-peak velocity, and trajectory straightness) and movement patterns (using Statistical Parametric Mapping) during the execution of three unimanual, relevant tasks before the intervention, after and at 6 months follow-up. Adding AOT to mCIMT mainly affected movement duration during reaching, whereas little benefit is seen on UL movement patterns. mCIMT, with or without AOT, improved peak velocity and trajectory straightness, and proximal movement patterns. These results highlight the importance of including kinematics in an UL evaluation to capture changes in motor control and movement patterns of the proximal joints.

<p>Effectiveness of Action Observation Training on Upper Limb Motor Function in Children with Hemiplegic Cerebral Palsy: A Systematic Review of Randomized Controlled Trials</p>

“…The training durations were ranged from 20 minutes to 1 hour per session, 1 up to 5 times per week, for three weeks to six months. 18,20,33 The characteristics of the intervention expressed as mean values (range) were: 12 min of AOT for each session (9-18); 4 min for each video; 10.7 min of observed action performance (3-36); 5 sessions a week (3-7); the total duration of treatment=46.7 days (9-180 days). In all studies, the control group performed the same actions as the experimental group for the same amount of time.…”

“…All eight studies administered AOT through goal-directed videos with specific hand/arm motor skill contents and afterward, the participants were asked to execute the same action. 18,20,[30][31][32][33][34] Only one study involved home-based AOT with repeated practice, 35 and two studies conducted combining AOT with mCIMT. 31,33…”

“…Two trials utilized WeeFIM and QUEST, designed to evaluate functional independence, movement patterns, and hand function. 30,32 Five studies used the ABILHAND-Kids test to assess manual ability in children with CP, 19,30,31,33,35 and two studies used BBT. 32,36 Five studies used the Melbourne Assessment Scale to evaluate the physical function and structure of children with UCP.…”

“…32,36 Five studies used the Melbourne Assessment Scale to evaluate the physical function and structure of children with UCP. 18,20,[33][34][35] Similarly, another four studies performed a measure of upper limb motor function by using AHA. 20,[33][34][35]…”

“…Out of the nine trials, eight of them (n=175) confirmed that the body function of CP children was significantly improved in AOT groups as compared to the control groups in all outcome measures (AHA, MA2). 18,20,[30][31][32][33][34]36 However, only one study 35 (n=59) reported the action observation therapy had no significant improvement on the upper limb motor function compared to that of the control groups. Within the experimental intervention group, considerable improvement was found in upper limb function recovery in both outcome measures (AHA and MA2) at 3 month tests.…”