Objective: To evaluate the effects of constraint-induced movement therapy on the use of the affected arm and on daily functioning in children with hemiplegic cerebral palsy.
Design: A single-blinded randomized clinical trial.
Subjects: Sixteen children with cerebral palsy randomized to intervention (n = 8, 4 males, 4 females, mean age 5 years and 6 months) and control groups (n = 8, 4 males, 4 females, mean age 6 years and 7 months).
Interventions: Non-affected arm of intervention group was restricted for 10 hours/ day and the affected arm intensively trained for 3 hours/day for two weeks. The intervention protocol included one week of bimanual functional training following constraint therapy. The control group maintained usual rehabilitation throughout the intervention period.
Main Measures: Pediatric Evaluation of Disability Inventory (self-care domain) and an adapted version of the Jebsen-Taylor test were administered before and after intervention, and at one month follow-up. General linear models tested differences in gain scores and the number needed to treat estimated relative effectiveness of intervention protocol for functional skills and independence in self-care.
Results: Results are reported for 15 children who completed assessments and intervention. Higher gains were observed in the intervention group for functional skills and independence post intervention (d(functional skills) = 1.61, P =0.0134; d(independence)=1.37; P =0.0001) and follow-up (d(functional skills) = 2.08, P =0.004; d(independence) = 0.85; P =0.0016). No group difference in manual dexterity gains was observed. Low indices of number needed to treat (1.75 and 2.33) illustrate clinical relevance of intervention.
Conclusions: The protocol associating constraint-induced movement therapy and bimanual functional training was effective in promoting daily living functioning among children with cerebral palsy.
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Article Synopsis
- The study aimed to compare the effectiveness of constraint-induced movement therapy (Baby-CIMT) and bimanual therapy (Baby-BIM) in infants at high risk for unilateral cerebral palsy.
- A total of 96 infants were randomly assigned to either therapy group, with both interventions yielding significant improvements in hand development, though neither was found to be superior to the other.
- Infants starting therapy before 6 months of corrected age showed greater enhancements in hand function compared to those who began later, indicating the importance of early intervention.
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