Effects of constraint-induced movement therapy in young children with hemiplegic cerebral palsy: an adapted model

Abstract

The aim of this study was to evaluate the effects of a modified version of constraint-induced (CI) movement therapy on bimanual hand-use in children with hemiplegic cerebral palsy (CP; age range 18 mo to 4 y) and to make a comparison with conventional paediatric treatment. Twenty-one children (13 females, eight males) completed the CI therapy programme and 20 children (12 males, eight females) served as a control group. Children in the CI therapy group were expected to wear a restraint glove for 2 hours each day over a period of 2 months. The training was based on principles of motor learning used in play and in motivational settings. To evaluate the effect of treatment, the Assisting Hand Assessment (AHA) was used. Assessments took place on three occasions: at onset, after 2 months, and 6 months after the first assessment. A significant interaction was found between group and AHA measure (ANOVA, F(2,74) = 5.64, p = 0.005). The children who received CI therapy improved their ability to use their hemiplegic hand significantly more than the children in the control group after 2 months, i.e. after treatment. Effect size was high after treatment and remained medium at 6 months. As the treatment was tailored to each child's capacity and interests, little frustration was experienced by the children.

Multicenter Randomized Controlled Trial of Pediatric Constraint-Induced Movement Therapy: 6-Month Follow-Up

“…Aarts et al (2011) applied 72 hr of intervention (3 hr/day, 3 days/wk, for 8 wk), achieving a moderate effect on the AHA (d 5 0.43) and a large effect on the ABILHAND-Kids (d 5 1.01). When Eliasson et al (2005) administered 120 hr of intervention, the effect size was large (d 5 1.16) for AHA scores and was maintained at 6 mo (d 5 0.72). These effect sizes are similar to our effect size for the AHA (h 2 5 .62).…”

“…Several CIMT trials with children have been published in the past decade (Aarts, Jongerium, Geerdink, van Wang, 2005;Taub, Ramey, DeLuca, & Echols, 2004;Stearns, Burtner, Keenen, Qualls, & Phillips, 2009;Willis, Morello, Davie, Rice, & Bennett, 2002). Eliasson and colleagues (2005) conducted a controlled and blinded clinical trial of 41 children (ages 18 mo-4 yr) in Sweden in which 25 participants completed 2 mo of CIMT and 20 served as a control group.…”

Upper limb function after botulinum toxin A treatment in cerebral palsy: Two years follow-up of six cases

“…This highlights the importance of motivating, well-planned and individually structured post-treatment rehabilitation, as BTXA alone does not ensure longstanding results. Recently, a modified constraint-induced therapy [21,22] has yielded promising results as a therapy with hemiplegic adolescents and adults with CP and combination of these two modalities remains to be assessed. Further, repeated injections beginning at the age of 3 may be expensive or may lead to non-responsiveness due to the formation of antibodies [23], thus emphasizing the need to combine the BTXA treatment with other methods (i.e.…”

Multisite Trial on Efficacy of Constraint-Induced Movement Therapy in Children with Hemiplegia

“…The first significant variant regard the method used to restrain the nonaffected limb: a broad range of techniques has been used from a glove or mitt, 12 to slings, 13,14 short-arm casts 15 and long-arm casts. 16 Second, treatment programs vary in intensity and typology, ranging from 2 mos of intervention 7 days per week, 16 2 hrs per day 12 to twice weekly in 30 min-sessions for 6 wks. 15 Moreover, there is inconsistency in the length of time the child's nonaffected limb is restrained, varying from 6 hrs per day, all day, 15,16 for a period of 10 days, 14 to 2 mos.…”