Feasibility of a Day-Camp Model of Modified Constraint-Induced Movement Therapy With and Without Botulinum Toxin A Injection for Children With Hemiplegia

Abstract

The objective of the study was to investigate the feasibility of modified constraint-induced (CI) therapy provided in a 2-week day-camp model with and without intramuscular botulinum toxin type A (BoNT-A) injections for children with congenital cerebral palsy. Sixteen children with congenital hemiplegia, Manual Ability Classification System (MACS) level I and II, aged 8-17 years, participated in a CI therapy day camp; of whom five participants (aged 11-16 years) received intramuscular BoNT-A prior to CI therapy. Assessments were conducted 4 months and 2 weeks before (baselines 1 and 2), immediately after, and 6 months after the day camp. For the children who received BoNT-A, no statistical analyses were conducted due to the small size of the sample. In this group, consistent improvement was only found according to the Melbourne Unilateral Limb Assessment. The children who received only the CI therapy demonstrated improvements in the Jebsen-Taylor Hand Function Test (p =. 04) at posttest, but improvements were not sustained at 6-month follow-up. No significant improvement was obtained for the Melbourne Assessment or the Assisting Hand Assessment. Children in both groups improved on specially trained tasks: frisbee golf, stacking blocks, and in-hand manipulation. Feedback from the participants suggests that the day-camp model is a feasible intervention following intramuscular BoNT-A injections. The results suggest that children with congenital hemiplegia with varying severity of impairment in hand function may benefit from CI therapy, but not every child demonstrates improvements in hand function. The characteristics of children who respond the best to CI therapy are not clear.

The Jebsen Taylor Test of Hand Function: A Pilot Test–Retest Reliability Study in Typically Developing Children

“…This change does not exceed the SRD calculated in the present study, and may therefore constitute acceptable variability. In the second treatment group ('CI with BoNT-A', n = 5), the median JTTHF total score decreased by approximately 56 seconds in the pre-intervention period (Eliasson et al, 2009), far exceeding the SRD presented here. This decrease may also constitute acceptable reliability given that children with CP are a significantly more heterogeneous population than TDC with respect to the JTTHF, statistically leading to a larger SRD.…”

“…In a feasibility study for an intervention model for children with CP, The JTTHF showed less stability than expected between pre-screening and baseline scores over a 4-month interval (Eliasson et al, 2009). In one of the two treatment groups ('CI', Downloaded by [University of Tasmania] at 09:33 01 October 2015 n = 11), the median JTTHF total score decreased by approximately 5 seconds over this pre-intervention period.…”

“…no Smallest Real Difference (SRD) or Minimal Clinically Important Difference (MCID) has been established in TDC). In a 2009 intervention feasibility study in children aged 8 to 17 years with cerebral palsy, the test showed less stability than expected between pre-screening and baseline scores (Eliasson et al, 2009). Examination of the stability of JTTHF scores over time in typically developing children may help to understand this finding.…”

Assisting Hand Assessment and Children's Hand-Use Experience Questionnaire –Observed Versus Perceived Bimanual Performance in Children with Unilateral Cerebral Palsy

“…In this study, we used the recently developed version of AHA for children or adolescents over 12 years of age (personal communication with Krumlinde-Sundholm, 23 February, 2015). This version requires adaptation of the test situation but can be used with the same scoring criteria, as previously demonstrated in several studies, including (Eliasson et al, 2009). The lack of published research into the psychometric prop-erties of the adolescents' version of AHA might be considered a limitation as might be the time lag that accompanied the AHA and CHEQ data collection.…”

Bimanuality is improved by hand surgery in children with brain lesions

“…It is unlikely that the functional improvement is only due to postoperative training, as Holmefur et al [28] have shown in a longitudinal study that children with CP above the age of 6 years have already reached their AHA score plateau. This means that it is not easy to achieve improvement of bimanual ability with only training within this age group even if the training intensity is high [40,41]. Clear training effect in this age group has only been seen after Constraint-induced movement therapy which is a very intensive type of training [42].…”