Efficacy of the use of unaffected hand containment in unimanual intensive therapy to increase visuomotor coordination in children with hemiplegia: a randomized controlled pilot study

Abstract

Background: The capacity of children with hemiplegia to be engaged in anticipatory action planning is affected. There is no balance among spatial, proprioceptive and visual information, thus altering the affected upper limb visuomotor coordination. The objective of the present study was to assess the improvement in visuomotor coordination after the application of a unimanual intensive therapy program, with the use of unaffected hand containment compared with not using unaffected hand containment. Methods: A simple blind randomized clinical trial was realized. A total of 16 subjects with congenital infantile hemiplegia participated in the study with an age mean of 5.54 years old (SD:1.55). Two intensive protocols for 5 weeks of modified constraint-induced movement therapy (mCIMT) or unimanual therapy without containment (UTWC) were executed 5 days per week (2 h/day). Affected upper limb visuomotor coordination (reaction time, task total time, active range, dynamic grasp) was measured before–after intensive therapy using a specific circuit with different slopes (10°/15°). Results: Statistically significant inter-group differences were found after the intervention, with clinically relevant results for the mCIMT group not seen in UTWC, in the following variables: reaction time 10°slope ( p = 0.003, d = 2.44), reaction time 15°slope ( p = 0.002, d = 2.15) as well as for the task total time 10°slope ( p = 0.002, d = 2.25), active reach 10°slope ( p = 0.002, d = 2.7), active reach 15°slope ( p = 0.003, d = 2.29) and dynamic grasp 10°/15°slopes ( p = <0.001, d = 2.69). There were not statistically significant inter-group differences in the total task time with 15°slope ( p = 0.074, d = 1.27). Conclusions: The use of unaffected hand containment in mCIMT would allow improvements in the affected upper limb’s visuomotor coordination. Thus, it would favor clinical practice to make decisions on therapeutic approaches to increase the affected upper limb functionality and action planning in children diagnosed with infantile hemiplegia (4–8 years old).

Shall we start? Ready, set, go! Toward early intervention in infants with unilateral cerebral palsy. A randomized clinical trial protocol

“…The activities will be the same as planned in the infant-mCIMT (see section ‘Infant-mCIMT protocol’) but without using the restraint in the unaffected upper limb. 23 , 24 …”

“…The activities will be the same as planned in the infant-mCIMT (see section 'Infant-mCIMT protocol') but without using the restraint in the unaffected upper limb. 23,24 Families follow-up For the three intensive therapy groups (infant-mCIMT, infant-BIT, and infant-hybrid) and the CG, a weekly follow-up will be carried out by a pediatric physiotherapist. The follow-up is aimed at resolving the doubts of the parents about the different therapies (unimanual/bimanual activities, restraint type or complications in its use, massage maneuvers.…”

Gross motor dysfunction and balance impairments in children and adolescents with Down syndrome: a systematic review

“…(10) Additionally, reaction time and execution time were also measured to estimate the delay in performing a movement following the command while maintaining standing balance and the total time taken to complete the entire task at hand, respectively. (11) For static balance, the measurements were taken in an upright standing position, barefoot with arms by the side and feet positioned 30 o relative to each other and heels 5 cm apart for 30 seconds. One study assessed dynamic balance function by recording Center of Pressure measurements while the participants stand in natural stance on the force platform and throw a ball.…”

Combined intensive therapies at home in spastic unilateral cerebral palsy with high bimanual functional performance. What do they offer? A comparative randomised clinical trial

“…59,61 In the mCIMT-B group, changes were obtained, reducing the execution time of the task, since the application of mCIMT reduces reaction time and favours visuomotor coordination through unimanual practice and unaffected hand containment. 71 Thus, the child could develop functional strategies for the execution of activities with better action planning due to repetition of the task. 72 Therefore, the application of 80 h of BIT would be sufficient to obtain results in the affected upper limb-use experience.…”