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Published on: August 9, 2024
Effect of treatment environment on modified constraint-induced movement therapy results in children with spastic
Hamid Reza Rostami1, R Azizi Malamiri
1Department of Occupational Therapy, Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. rostamihr@ajums.ac.ir
Insights
Modified constraint-induced movement therapy (mCIMT) improved upper limb function in children with cerebral palsy. Home-based therapy led to sustained improvements compared to clinic-based therapy, suggesting natural context practice is preferred.
Area of Science:
- Pediatric Rehabilitation
- Neurorehabilitation
- Motor Control in Cerebral Palsy
Background:
- Spastic hemiplegic cerebral palsy (CP) significantly impacts upper limb function in children.
- Constraint-induced movement therapy (CIMT) is a promising intervention for improving motor skills in pediatric CP.
- Understanding the optimal treatment environment for modified CIMT (mCIMT) is crucial for maximizing therapeutic outcomes.
Purpose of the Study:
- To compare the effectiveness of home-based versus clinic-based modified constraint-induced movement therapy (mCIMT) for children with spastic hemiplegic cerebral palsy.
- To evaluate the impact of the treatment environment on the short-term and long-term outcomes of mCIMT.
- To determine if practicing mCIMT in a natural context (home) enhances functional improvements.
Main Methods:
- A single-blinded, randomized controlled trial involving 14 children with spastic hemiplegic CP.
- Participants received 15 hours of mCIMT over 10 sessions, randomly assigned to either a home-based or clinic-based environment.
- Motor function was assessed pre-treatment, post-treatment, and at a 3-month follow-up using the pediatric Motor Activity Log and specific subtests of the Bruininks-Oseretsky Test of Motor Proficiency.
Main Results:
- All participants demonstrated significant improvements in upper limb function post-treatment, with the exception of upper limb coordination (Subtest 5).
- Children receiving home-based mCIMT exhibited significantly continued improvement at the 3-month follow-up across all measured outcomes.
- The clinic-based group did not show the same sustained level of improvement at follow-up.
Conclusions:
- Modified constraint-induced movement therapy (mCIMT) is an effective intervention for enhancing upper limb function in children with spastic hemiplegic cerebral palsy.
- Treating children in their home environment, a natural context, appears to promote more sustained functional gains compared to clinic-based therapy.
- Home-based mCIMT is recommended as a preferred therapeutic approach for this population due to its superior long-term outcomes.
Purpose:
To determine the effects of treatment environment (home and clinic) on results of modified constraint-induced movement therapy (modified CIMT) in children with spastic hemiplegic cerebral palsy.
Method:
In a single-blinded, randomized, controlled trial, 14 children with spastic hemiplegic cerebral palsy (5 females, 9 males; mean age: 74 months) received 15 hours of modified CIMT, occurring three times/week for 10 sessions every other day in two randomly assigned groups. Each session lasts one and half hours. Treatment environment for intervention group (n = 7) was home and for control group (n = 7) was clinic. Measures were conducted pre, post and 3 months after treatment period by pediatrics motor activity log and subtests 5 (upper limb coordination) and 8 (upper limb speed and dexterity) of Bruininks-Oseretsky test of motor proficiency. Sample randomization and data analysis by analysis of variance with repeated measures were conducted by SPSS-16 software in α level set at p < 0.05.
Results:
All subjects showed significant improvement (p < 0.01) in post-test measures except subtest 5 of Bruininks-Oseretsky test of motor proficiency. In contrast to clinic group, subjects in home showed significantly continued improvement at follow-up session in all measures.
Conclusions:
Modified CIMT is effective in improving upper limb function in children with spastic hemiplegic cerebral palsy. In addition, more improved performance in home group places the practice in natural context as the preferred method for treatment of these children.
