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Constraint-induced movement therapy for children with obstetric brachial plexus palsy: two single-case series
Francisca Eugster Buesch1, Barbara Schlaepfer, Eling D de Bruin
1Rehabilitation Centre Affoltern am Albis, University Children's Hospital, ETH, Zurich, Switzerland.
Insights
This pilot study explored constraint-induced movement therapy (CIMT) for children with obstetric brachial plexus palsy. While some arm function improved, results suggest further research is needed for substantial gains.
Area of Science:
- Pediatric Rehabilitation
- Neurology
- Physical Therapy
Background:
- Obstetric brachial plexus palsy (OBPP) affects upper limb function in children.
- Constraint-Induced Movement Therapy (CIMT) is a potential intervention for improving motor control.
- Feasibility and preliminary efficacy of CIMT in OBPP require further investigation.
Purpose of the Study:
- To assess the feasibility of a home-based CIMT program for children with OBPP.
- To gather preliminary data on functional upper limb improvements following CIMT.
- To inform future research, including randomized clinical trials.
Main Methods:
- A pilot study involving two 12-year-old patients with OBPP.
- A 126-hour home-based CIMT intervention over 3-4.5 weeks.
- Utilized ABA single-case design with assessments: Assisted Hand Assessment, Melbourne Assessment of Unilateral Upper Limb function, and Nine-hole Peg Test.
Main Results:
- Both patients showed improvements in the Assisted Hand Assessment and Melbourne Assessment of Unilateral Upper Limb function.
- No significant improvement was observed in the Nine-hole Peg Test for either patient.
- Statistical analysis indicated potential relationships between CIMT and observed functional changes in one patient.
Conclusions:
- CIMT appears feasible for children with OBPP, showing some positive functional changes.
- Observed improvements may not be substantial, warranting further investigation.
- Child-friendly CIMT adaptations and compliance monitoring are crucial for future trials.
Abstract:
The objective of this pilot study was to investigate the feasibility of constraint-induced movement therapy (CIMT) in children with obstetric brachial plexus palsy and receive preliminary information about functional improvements. Two patients (age 12 years) with obstetric brachial plexus palsy were included for a 126-h home-based CIMT intervention (3 and 4.5 weeks) and weekly monitored with the Melbourne Assessment of Unilateral Upper Limb function and the Nine-hole Peg Test. The Assisted Hand Assessment was performed 3 weeks before the beginning of intervention, preintervention, postintervention, and at 3 weeks follow-up (ABA single-case design). Tests were analyzed descriptively, visually, and where possible, using a time series analysis with C statistic. Results revealed changes of arm function in both patients between preintervention and follow-up test as follows: Assisted Hand Assessment from 85 to 92% in patient A and 80 to 89% in patient B, in the Melbourne Assessment of Unilateral Upper Limb function from 87 to 90% (C=0.578, z=1.876, P<0.05) in patient A and 72 to 80% (C=0.827, z=2.68, P<0.005) in patient B. There was no improvement in the Nine-hole Peg Test in both patients. Improvements as a result of CIMT found in this pilot study may not be considered substantial. However, they justify further research as some findings indicate relationship to the CIMT intervention in the 'B' phase. To enhance motivation and to plan a controlled, randomized clinical trial, child-friendly applications of the CIMT concept and adequate measures to monitor compliance are being discussed.
