Improvement of upper extremity motor control and function after home-based constraint induced therapy in children
Hsieh-ching Chen1, Chia-ling Chen2, Lin-ju Kang3
1Department of Industrial Engineering and Management, National Taipei University of Technology, Taipei.
Insights
Home-based constraint-induced therapy (CIT) improved motor control and function in children with unilateral cerebral palsy (CP) for up to six months. This therapy enhanced movement efficiency and grasping compared to traditional rehabilitation.
Area of Science:
- Pediatric Rehabilitation
- Neurorehabilitation
- Motor Control Research
Background:
- Unilateral cerebral palsy (CP) significantly impacts motor function in children.
- Constraint-induced therapy (CIT) shows promise in improving upper extremity function.
- Investigating home-based models of CIT is crucial for accessibility and long-term adherence.
Purpose of the Study:
- To evaluate the long-term effects of home-based constraint-induced therapy (CIT) on motor control and functional outcomes.
- To compare home-based CIT with traditional rehabilitation (TR) in children with unilateral CP.
- To assess the durability of treatment effects up to six months post-intervention.
Main Methods:
- A randomized controlled trial involving 45 children (aged 6-12 years) with unilateral CP.
- Participants were assigned to either home-based CIT (intensive affected arm training with less affected arm restraint) or TR (unimanual and bimanual training).
- Kinematic and clinical assessments were conducted at baseline, post-treatment, and at 3 and 6 months follow-up.
Main Results:
- The home-based CIT group demonstrated significantly improved reach-to-grasp kinematics, including shorter reaction time and normalized movement time.
- CIT led to more efficient grasping (smaller MGA) and better movement preplanning/execution (fewer normalized movement units).
- Significant improvements were observed in motor skills (PDMS-2, BOTMP) and functional independence (WeeFIM) for the CIT group compared to TR.
Conclusions:
- Home-based CIT provides superior spatial and temporal efficiency in motor control for children with unilateral CP.
- The observed benefits in motor control and functional abilities persist for at least six months post-treatment.
- Home-based CIT is an effective therapeutic approach for improving long-term outcomes in pediatric unilateral CP.
Objective:
To investigate the long-term effects of home-based constraint induced therapy (CIT) on motor control underlying functional change in children with unilateral cerebral palsy (CP).
Design:
Randomized controlled trial.
Setting:
Home based.
Participants:
Children with unilateral CP (N=45; aged 6-12 y) were randomly assigned to receive home-based CIT (n=23) or traditional rehabilitation (TR) (n=22).
Interventions:
Both groups received a 4-week therapist-based intervention at home. The home-based CIT involved intensive functional training of the more affected upper extremity during which the less affected one was restrained. The TR involved functional unimanual and bimanual training.
Main Outcome Measures:
All children underwent kinematic and clinical assessments at baseline, 4 weeks (posttreatment), and 3 and 6 months (follow-up). The reach-to-grasp kinematics were reaction time (RT), normalized movement time, normalized movement unit, peak velocity (PV), maximum grip aperture (MGA), and percentage of movement where MGA occurs. The clinical measures were the Peabody Developmental Motor Scales, Second Edition (PDMS-2), Bruininks-Oseretsky Test of Motor Proficiency (BOTMP), and Functional Independence Measure for children (WeeFIM).
Results:
The home-based CIT group showed a shorter RT (P<.05) and normalized movement time (P<.01), smaller MGA (P=.006), and fewer normalized movement units (P=.014) in the reach-to-grasp movements at posttreatment and follow-up than the TR group. The home-based CIT group improved more on the PDMS-2 (P<.001) and WeeFIM (P<.01) in all posttreatment tests and on the BOTMP (P<.01) at follow-up than the TR group.
Conclusions:
The home-based CIT induced better spatial and temporal efficiency (smoother movement, more efficient grasping, better movement preplanning and execution) for functional improvement up to 6 months after treatment than TR.
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