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

Eliasson, Ann‐Christin; Sundholm, Lena Krumlinde; Shaw, Karin; Wang, Chen

doi:10.1111/j.1469-8749.2005.tb01132.x

Cited by 111 publications

(257 citation statements)

References 43 publications

(43 reference statements)

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“…The same principles of activity-based plasticity can be harnassed causing CIMT for children with hemiplegic cerebral palsy. fMRI studies of cerebral activation of children with hemiplegia showed a shift in laterality from the ipsilateral to contralateral hemisphere after CIMT therapy in association with improved function [Eliasson et al, 2005]. Kuhnke et al [2008] found that children with congenital hemiparesis and preserved contralateral corticospinal tracts from the damaged hemisphere respond differentially to CIMT than children with only ipsilateral responses to TMS.…”

Section: Plasticity In Children With Cerebral Palsymentioning

confidence: 99%

Plasticity in the developing brain: Implications for rehabilitation

Johnston

2009

Dev Disabil Res Revs

418

276

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Neuronal plasticity allows the central nervous system to learn skills and remember information, to reorganize neuronal networks in response to environmental stimulation, and to recover from brain and spinal cord injuries. Neuronal plasticity is enhanced in the developing brain and it is usually adaptive and beneficial but can also be maladaptive and responsible for neurological disorders in some situations. Basic mechanisms that are involved in plasticity include neurogenesis, programmed cell death, and activity-dependent synaptic plasticity. Repetitive stimulation of synapses can cause long-term potentiation or long-term depression of neurotransmission. These changes are associated with physical changes in dendritic spines and neuronal circuits. Overproduction of synapses during postnatal development in children contributes to enhanced plasticity by providing an excess of synapses that are pruned during early adolescence. Clinical examples of adaptive neuronal plasticity include reorganization of cortical maps of the fingers in response to practice playing a stringed instrument and constraint-induced movement therapy to improve hemiparesis caused by stroke or cerebral palsy. These forms of plasticity are associated with structural and functional changes in the brain that can be detected with magnetic resonance imaging, positron emission tomography, or transcranial magnetic stimulation (TMS). TMS and other forms of brain stimulation are also being used experimentally to enhance brain plasticity and recovery of function. Plasticity is also influenced by genetic factors such as mutations in brain-derived neuronal growth factor. Understanding brain plasticity provides a basis for developing better therapies to improve outcome from acquired brain injuries. ' 2009 Wiley-Liss, Inc. Dev Disabil Res Rev 200915:94-101.

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Section: Plasticity In Children With Cerebral Palsymentioning

confidence: 99%

Plasticity in the developing brain: Implications for rehabilitation

Johnston

2009

Dev Disabil Res Revs

418

276

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“…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.…”

Section: Resultsmentioning

confidence: 99%

“…3,4 For a subgroup of children we also have information about the basic pattern of brain damage. Because of the importance of understanding the long-term effect of mCIMT, it was of interest to undertake a secondary analysis of these previously collected data.…”

Section: Resultsmentioning

confidence: 99%

“…3 Children wore a restraining fabric glove with a built-in volar stiff plastic splint on the dominant hand. The glove prevented them from using the hand for grasping, but they could use the hand for support.…”

Section: The Adapted Model Of Constraint-induced Movement Therapymentioning

confidence: 99%

“…In a previous study of longitudinal development, 11 about half of the children had been involved in an mCIMT programme (2h of daily training over 8wks) at around 2 to 3 years of age and the therapy had had a positive effect. 3,4 For a subgroup of children we also have information about the basic pattern of brain damage. Because of the importance of understanding the long-term effect of mCIMT, it was of interest to undertake a secondary analysis of these previously collected data.…”

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confidence: 99%

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

Eliasson

Holmefur

2014

Develop Med Child Neuro

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AHAAssisting Hand Assessment MCA Middle cerebral artery mCIMT Modified constraint-induced movement therapy WDMI White matter damage of immaturity AIM There is evidence that modified constraint-induced movement therapy (mCIMT) has a short-term positive effect on hand function in children with unilateral cerebral palsy (CP), but the long-term effect is unknown. The aim of this study was to investigate whether or not a single block of mCIMT (2h/d for 2mo) at age 2 to 3 years influences the course of development of bimanual hand function at around 8 years of age.METHOD A convenience sample of 45 children (24 males, 21 females) with unilateral CP and mean (SD) age at first assessment 32 months (13mo) was included in this study. The participants were divided into the mCIMT group (n=26) and the reference group (no mCIMT; n=19). Brain lesion characteristics were available for 32 children. The children were measured repeatedly with the Assisting Hand Assessment (AHA) for a mean period of 4 years and 6 months. Development curves were created and compared with a non-linear mixed effects model. RESULTSChildren who were receiving mCIMT had an upper limit of development of bimanual hand function that was 8.5 AHA units higher than in the reference group (p=0.022). However, when controlling for brain lesion characteristics and baseline in a subgroup of 32 children, the difference was considerably smaller and no longer significant.CONCLUSION mCIMT may have a positive impact on long-term development of bimanual hand function, but the results are inconclusive and further research is necessary.There is evidence from higher-level studies that modified constraint-induced movement therapy (mCIMT) is effective at improving hand function in children with unilateral cerebral palsy (CP). 1,2 The effect is maintained for at least 6 months after the therapy ends 3-7 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. 9The possible long-term impact of mCIMT is of great importance not only for children and their families, but also for health care providers when prioritizing and organizing resources. According to a recent consensus report, the long-term impact of this therapy has also been identified as one of the very important questions to explore in future research.9 Longer-term follow-up is complicated, however, because outcomes are susceptible to influences from other treatments and ongoing development. Further, it is questionable whether one block of mCIMT at an early age can be expected to have a notable impact after several years.We have previously shown that the Assisting Hand Assessment (AHA) measure at 18 months of age can predict both the rate and the ability limit of development. The most dramatic development of hand function occured in the early preschool period (before age 3y), at least in the case of the most able children, who spontaneously u...

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Constraint‐induced movement therapy (CIMT): Pediatric applications

Brady

Garcia

2009

Dev Disabil Res Revs

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The purpose of this article is to describe theoretical and research bases for constraint‐induced movement therapy (CIMT), to discuss key features and variations in protocols currently in use with children, and to review the results of studies of efficacy. CIMT has been found to be an effective intervention for increasing functional use of the hemiparetic upper extremity in adults with chronic disability from stroke. CIMT developed out of behavioral research on the phenomenon of “learned nonuse” of an upper extremity, commonly observed following sensory and/or motor CNS injury, in which failure to regain use persists even after a period of partial recovery. CIMT includes three key elements: (1) constraining the use of the less‐impaired upper extremity (UE); (2) intensive, repetitive daily therapist‐directed practice of motor movements with the impaired UE for an extended period (2–3 weeks); and (3) shaping of more complex action patterns through a process of rewarding successive approximations to the target action. Mechanisms responsible for success are thought to be separate but complementary, that is, operant conditioning (reversal of learned nonuse) and experience‐driven cortical reorganization. CIMT has recently been extended to children with hemiparesis secondary to perinatal stroke or other CNS pathology. Numerous case studies, as well as a small number of randomized controlled or controlled clinical trials have reported substantial gains in functional use of the hemiplegic UE following CIMT with children. Protocols vary widely in terms of type of constraint used, intensity and duration of training, and outcome measures. In general, all report gains in functional use, with minimal or no adverse effects. Continued research is needed, to clarify optimal protocol parameters and to further understand mechanisms of efficacy. © 2009 Wiley‐Liss, Inc. Dev Disabil Res Rev 2009;15:102–111.

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

Cited by 111 publications

References 43 publications

Plasticity in the developing brain: Implications for rehabilitation

Plasticity in the developing brain: Implications for rehabilitation

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

Constraint‐induced movement therapy (CIMT): Pediatric applications

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