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Comparing Unimanual and Bimanual Training in Upper Extremity Function in Children With Unilateral Cerebral Palsy
Susan E Klepper1, Debra Clayton Krasinski, Meaghan C Gilb
1Program in Physical Therapy and Department of Rehabilitation and Regenerative Medicine (Drs Klepper and Krasinski), Columbia University, New York; Rusk Institute (Dr. Khalil), New York University Medical Center, New York; and Children's Health (Dr. Gilb), Children's Medical Center of Dallas, Dallas, Texas.
Insights
This review found both intensive bimanual therapy (IBT) and modified constraint-induced movement therapy (mCIMT) effective for improving upper limb function in children with unilateral cerebral palsy (CP). IBT showed a slight advantage in movement quality and parent-reported outcomes.
Area of Science:
- Pediatrics
- Rehabilitation Medicine
- Neuroscience
Background:
- Unilateral cerebral palsy (CP) significantly impacts upper limb function in children.
- Therapeutic interventions aim to enhance motor skills and functional independence.
- Comparing different therapy approaches is crucial for optimizing treatment strategies.
Purpose of the Study:
- To systematically review and compare the efficacy of intensive bimanual therapy (IBT) and modified constraint-induced movement therapy (mCIMT).
- To evaluate the impact of these therapies on upper limb function in children diagnosed with unilateral CP.
Main Methods:
- A systematic review of randomized control trials (RCTs) published between 2009 and October 2015.
- Searched four electronic databases for relevant comparative studies.
- Included 5 RCTs involving 221 participants (ages 1.5-16 years) with unilateral CP.
Main Results:
- Both IBT and mCIMT demonstrated effectiveness in improving unimanual movement quality, bimanual capacity, and movement efficiency.
- Intensive bimanual therapy (IBT) received a specific, albeit weak, recommendation for enhancing movement quality.
- IBT also received a weak, specific recommendation for improving outcomes reported by parents.
Conclusions:
- A strong, general recommendation supports both IBT and mCIMT for improving various aspects of upper limb function in pediatric unilateral CP.
- IBT may offer specific benefits for movement quality and parent-perceived functional improvements.
Purpose:
This systematic review compared intensive bimanual therapy (IBT) and modified constraint-induced movement therapy (mCIMT) in upper limb function in children with unilateral cerebral palsy (CP).
Methods:
Four electronic databases were searched from 2009 through October 2015 for randomized control trials comparing IBT with mCIMT.
Results:
Eight articles met the inclusion criteria; 5 randomized clinical trials with 221 participants with unilateral CP, ages 1.5 to 16 years, who received the intervention in a day camp, clinical, or preschool setting were included. The IBT group performed bimanual motor activities; the mCIMT group performed unilateral motor activities.
Conclusion:
There was a strong, nonspecific recommendation for either approach to improve quality of unimanual movement, bimanual capacity, and movement efficiency. There was a weak, specific recommendation for IBT in improving movement quality and a specific but weak recommendation favoring IBT to improve the child's performance on parent-reported outcomes.
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