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

Abstract

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...

Longitudinal development of hand function in children with unilateral spastic cerebral palsy aged 18 months to 12 years

“…In a small study using various assessments of hand function, stable ability was seen over a 6-year period at 10 to 21 years of age. 15 Future studies that explore long-term development in relation to various factors that are assumed to affect the development of hand function in children with unilateral CP would supplement the predictive and prognostic information provided in this study. 13 Thus, further studies of development of hand function at older ages are needed -as indicated by the fact that contractures of the forearm are not commonly reported before 12 years of age, 14 although a limited active range of motion is present at an early age.…”

Development of bimanual performance in young children with cerebral palsy

“…21 A large proportion of the children with unilateral CP in our study had performed intensive training, and it is unknown whether this has influenced the developmental trajectories. 23 And for children with bilateral CP, the effect of hand training is unknown. 17,22 Despite knowledge of treatment effects, the long-term effects of intensive hand training for children with unilateral CP is inconclusive.…”

Improvements in bimanual hand function after baby-CIMT in two-year old children with unilateral cerebral palsy: A retrospective study

“…The impact of brain lesion on intervention outcome is rarely considered. One study demonstrates that one block of CIMT at age 2-3 years can predict better longitudinal development of bimanual hand use, but this treatment effect diminishes when controlling for brain lesion and baseline ability (Eliasson & Holmefur, 2014); in other studies of older children, the results are inconclusive (Islam et al, 2014;Kuhnke et al, 2008). The present retrospective cohort design including only one measure of the children's hand function could be seen as a weakness, because it does not establish a causal effect to the extent of an experimental design.…”