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Multicenter randomized controlled trial of pediatric constraint-induced movement therapy: 6-month follow-up
Jane Case-Smith1, Stephanie C DeLuca, Richard Stevenson
1Occupational Therapy Division, Ohio State University, 406 Atwell Hall, 453 West 10th Avenue, Columbus, OH 43210, USA. Jane.Case-Smith@osumc.edu
Insights
Constraint-induced movement therapy (CIMT) for pediatric unilateral cerebral palsy (CP) showed sustained improvements regardless of 3 or 6 hours daily dosage. This suggests optimal functional gains are achievable with either treatment intensity for children with CP.
Area of Science:
- Pediatric rehabilitation
- Neurology
- Occupational therapy
Background:
- Unilateral cerebral palsy (CP) significantly impacts motor function in children.
- Constraint-induced movement therapy (CIMT) is an emerging intervention for pediatric CP.
- Optimizing CIMT dosage for sustained functional gains requires further investigation.
Purpose of the Study:
- To compare the maintenance of functional gains 6 months post-treatment in children with unilateral CP receiving 6 hours versus 3 hours of daily CIMT.
- To test the hypothesis that higher daily CIMT dosage leads to greater long-term maintenance of improvements.
Main Methods:
- A multisite randomized controlled trial (RCT) involving 18 children (ages 3-6) with unilateral CP.
- Children were randomized to 3 or 6 hours of daily CIMT for 21 days, with a cast applied to the unaffected limb.
- Standardized assessments (Assisted Hand Assessment, Quality of Upper Extremity Skills Test, Pediatric Motor Activity Log) were administered pre- and post-treatment, with follow-ups at 1 week, 1 month, and 6 months.
Main Results:
- Both CIMT dosage groups demonstrated significant improvements across all measured functional outcomes.
- No statistically significant differences in the maintenance of gains were observed between the 6-hour and 3-hour groups at the 6-month follow-up.
- Effect sizes for pre- to post-intervention changes ranged from .33 to .80, indicating substantial improvements within both groups.
Conclusions:
- The study confirms the sustained positive effects of pediatric CIMT on functional performance in children with unilateral CP up to 6 months post-treatment.
- The hypothesis that a higher daily CIMT dosage (6 hours vs. 3 hours) results in superior long-term maintenance of gains was not supported.
- These findings suggest that both 3 and 6 hours of daily CIMT are effective for achieving lasting functional improvements in pediatric unilateral CP.
Objective:
Pediatric constraint-induced movement therapy (CIMT) is a promising intervention for children with unilateral cerebral palsy (CP). This multisite randomized controlled trial (RCT) tested the hypothesis that 6 hr versus 3 hr per day for 21 days would produce larger maintenance of gains 6 mo posttreatment.
Method:
Three sites recruited 18 children (6 per site) ages 3-6 yr with unilateral CP. Children were randomly assigned 3 to 6 hr/day of CIMT for 21 days and wore a cast on the unaffected extremity the first 18 days. Occupational therapists applied a standardized pediatric CIMT protocol. Evaluators blinded to condition administered the ASsisted Hand Assessment and the Quality of Upper Extremity Skills Test, and parents completed the Pediatric Motor Activity Log pre- and posttreatment (1 wk, 1 mo, and 6 mo).
Results:
Both CIMT dosage groups showed significant gains on all five assessments with no significant group differences at 6 mo follow-up. Effect sizes (n = 15) comparing preintervention to postintervention measures (partial η2) ranged from .33 to .80.
Conclusion:
The first multisite RCT of pediatric CIMT confirmed the maintenance of positive effects at 6 mo follow-up across multiple functional performance measures. The hypothesis that maintenance of effects would differ for children who received 6 versus 3 hr/day of CIMT (126 vs. 63 total hr) was not supported.
