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Improvements in bimanual hand function after baby-CIMT in two-year old children with unilateral cerebral palsy: A
Linda Nordstrand1, Marie Holmefur2, Annika Kits3
1Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
Insights
Early intensive therapy, specifically baby constraint-induced movement therapy (baby-CIMT), significantly improves hand function in young children with unilateral cerebral palsy (CP). Children receiving baby-CIMT were six times more likely to achieve high functional hand use by age two.
Area of Science:
- Pediatric Rehabilitation
- Neurodevelopmental Disorders
- Motor Function Research
Background:
- Early intervention is crucial for motor development in children with unilateral cerebral palsy (CP).
- The impact of early intensive therapy on hand function in unilateral CP remains under-investigated.
- Constraint-induced movement therapy (CIMT) shows promise for improving upper limb function.
Purpose of the Study:
- To investigate the effect of baby constraint-induced movement therapy (baby-CIMT) on hand function in children with unilateral CP at two years of age.
- To determine if early baby-CIMT influences bimanual hand use compared to no early intervention.
- To analyze the association between baby-CIMT and functional hand levels in young children with CP.
Main Methods:
- Retrospective study analyzing data from 72 children with unilateral CP.
- Administered the Assisting Hand Assessment (AHA) at approximately 21 months of age.
- Compared hand function outcomes between 31 children who received baby-CIMT and those who did not, controlling for brain lesion type.
Main Results:
- Children receiving baby-CIMT showed a significantly higher proportion of high functional hand levels at two years of age (OR 5.83).
- No significant difference was observed in the likelihood of very low functional hand levels between groups (OR 0.31).
- The study found a positive association between early baby-CIMT and improved hand function outcomes.
Conclusions:
- Early-onset baby-CIMT positively impacts hand function in children with unilateral CP.
- Baby-CIMT appears to promote higher levels of functional bimanual hand use by age two.
- These findings support the early implementation of baby-CIMT for enhancing motor development in unilateral CP.
Abstract:
The common assumption that early-onset intensive intervention positively affects motor development has rarely been investigated for hand function in children with unilateral cerebral palsy (CP). This retrospective study explored the possible impact of baby constraint-induced movement therapy (baby-CIMT) on hand function at two years of age. We hypothesized that baby-CIMT in the first year of life would lead to better bimanual hand use at two years of age than would not receiving baby-CIMT. The Assisting Hand Assessment (AHA) was administered at age 21 months (SD 2.4 months) in 72 children with unilateral CP, 31 of who received baby-CIMT. When dividing the children into four functional levels based on AHA, the proportional distribution differed between the groups in favour of baby-CIMT. Logistic regression analysis indicated that children in the baby-CIMT group were more likely than were children in the no baby-CIMT group to have a high functional level, even when controlling for the effect of brain lesion type (OR 5.83, 95% CI 1.44-23.56, p = 0.001). However, no difference was found between groups in the odds of having a very low functional level (OR 0.31, 95% CI 0.08-1.17, p = 0.084). The result shows that baby-CIMT at early age can have a positive effect. Children who received baby-CIMT were six times more likely to have a high functional level at two years of age than were children in the no baby-CIMT group.
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