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Randomized trial of modified constraint-induced movement therapy with and without an intensive therapy program in
Katrijn Klingels1, Hilde Feys, Guy Molenaers
11Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Belgium.
Insights
Adding intensive therapy to modified constraint-induced movement therapy (m-CIMT) improved hand function in children with cerebral palsy (CP). The combined approach showed greater benefits for bimanual performance than m-CIMT alone.
Area of Science:
- Pediatric Rehabilitation
- Neurology
- Occupational Therapy
Background:
- Unilateral cerebral palsy (CP) significantly impacts hand function in children.
- Constraint-induced movement therapy (CIMT) is a recognized intervention, but optimal approaches require further investigation.
- Modified CIMT (m-CIMT) is a common adaptation for pediatric CP.
Purpose of the Study:
- To evaluate the added benefits of an intensive therapy (IT) program combined with home-based m-CIMT.
- To assess improvements in hand function and related measures in children with unilateral CP.
Main Methods:
- Fifty-one children with unilateral CP were randomized to m-CIMT alone or m-CIMT + IT.
- Intervention involved 10 weeks of constraint wear (1 hr/day, 5 days/week).
- The m-CIMT + IT group received additional weekly sessions focusing on distal muscle strengthening and bimanual activities.
Main Results:
- The m-CIMT + IT group showed significantly better outcomes on the primary measure, Assisting Hand Assessment (AHA).
- Both groups improved in muscle tone, strength, and unimanual capacity.
- Younger children and those with poorer initial hand function benefited from both approaches; older children with better function benefited more from the combined therapy.
Conclusions:
- Combining m-CIMT with an intensive therapy program enhances bimanual performance in children with CP.
- The intensive therapy component specifically targets distal hand function and strength.
- This combined approach offers a more effective strategy for improving hand function in this population.
Background:
Constraint-induced movement therapy (CIMT) has gained emerging evidence and popularity in children with unilateral cerebral palsy (CP). However, many issues remain unanswered regarding the best approach.
Objective:
This study investigated the additional effects of an intensive therapy program to promote hand function combined with home-based modified CIMT (m-CIMT).
Methods:
. Fifty-one children (mean age 8 years 9 months) were randomized to m-CIMT alone or m-CIMT with intensive therapy (IT). All children had to wear a constraint on the unaffected hand for 1 hour, 5 days/week for 10 weeks. Children in the m-CIMT + IT group also received 3 sessions of 45 minutes weekly of intensive therapy for distal muscle strengthening and hand function, using unimanual and bimanual activities. The Assisting Hand Assessment (AHA) was the primary outcome measure. Secondary outcome measures were muscle tone, strength, Melbourne Assessment, Jebsen-Taylor test, and ABILHAND-Kids questionnaire. Assessments were administered at baseline, after intervention, and at 10-week follow-up.
Results:
Significant between-group differences in AHA were in favor of the m-CIMT + IT group (P = .04). Both groups demonstrated comparable improvements in muscle tone (P = .002), strength (P < .0001), grip strength (P = .02), and unimanual capacity (Melbourne Assessment and Jebsen-Taylor, P < .0001). Younger children and children with poorer hand function benefited from both interventions, whereas older children and children with better hand function only benefited from the combined approach.
Conclusions:
The combination of m-CIMT with an intensive therapy program on distal hand function and strength enhances the effects of m-CIMT alone for improving bimanual performance.
