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Effects of Modified Constraint-Induced Movement Therapy in Real-World Arm Use in Young Children with Unilateral
Young Sub Hwang1, Jeong-Yi Kwon1
1Department of Physical and Rehabilitation Medicine, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea.
Insights
Modified constraint-induced movement therapy (mCIMT) improved paretic arm use in young children with unilateral cerebral palsy (CP). This therapy, involving continuous restraint, showed positive real-world effects on affected hand function.
Area of Science:
- Pediatric Rehabilitation
- Neurology
- Occupational Therapy
Background:
- Unilateral cerebral palsy (CP) significantly impacts motor function in infants and toddlers.
- Effective interventions are needed to improve paretic arm use in daily activities.
- Constraint-induced movement therapy (CIMT) and its modifications show promise for this population.
Purpose of the Study:
- To evaluate the feasibility and effectiveness of modified constraint-induced movement therapy (mCIMT) with continuous restraint.
- To assess improvements in real-world paretic arm use among infants and toddlers with unilateral CP.
Main Methods:
- A single-blind randomized controlled trial was conducted with 24 children (7-36 months) diagnosed with unilateral CP.
- The experimental group received 3 weeks of clinic-based mCIMT (2 hours/day, 5 days/week) with continuous restraint.
- Outcomes were measured using PDMS-2, GMFM-66, PMAL, PEDI, and accelerometers.
Main Results:
- The mCIMT group demonstrated significant improvements in Pediatric Motor Activity Log (PMAL) scores for frequency and quality of use, and PDMS-2 visual-motor integration.
- Children in the mCIMT group who wore accelerometers showed increased moderate-to-vigorous physical activity and overall arm movement.
- These improvements were observed posttreatment compared to the control group.
Conclusions:
- Modified constraint-induced movement therapy (mCIMT) with continuous restraint is a feasible and effective intervention.
- The therapy positively impacts the real-world use of the paretic arm in infants and toddlers with unilateral CP.
- Further research can explore long-term effects and optimize mCIMT protocols.
Objective:
To determine whether modified constraint-induced movement therapy (mCIMT) with continuous restraint is feasible and effective in improving the use of the paretic arm in the real world among infants and toddlers with unilateral cerebral palsy (CP).
Design:
Single-blind randomized controlled trial.
Setting:
Tertiary hospital.
Participants:
Children aged 7 to 36 months with unilateral CP (N = 24; 16 boys, 8 girls).
Intervention:
The experimental group received 2-hour clinic-based mCIMT sessions (5 days per week for 3 weeks), and a continuous restraint was applied.
Main Outcome Measures:
Standardized assessments were conducted. Peabody Developmental Motor Scales-2 (PDMS-2), Gross Motor Function Measure-66, Pediatric Motor Activity Log (PMAL), and Pediatric Evaluation of Disability Inventory were measured pre- and postintervention. Children who agreed to participate in the accelerometer study additionally wore accelerometers on both their wrists for 3 days before and after the intervention.
Results:
The mCIMT group exhibited greater improvement in PMAL-how often (p = 0.048; ηp2 = 0.173), PMAL-how well (p = 0.008; ηp2 = 0.289), and PDMS-2 visual motor integration (p = 0.014; ηp2 = 0.256) posttreatment than the control group. The percentage of time in moderate-to-vigorous physical activity (z = -2.24; p = 0.03) and vector magnitude average counts (z = -2.52; p = 0.01) significantly increased in children in who wore accelerometers (N = 8) after the 3-week mCIMT protocol.
Conclusion:
mCIMT with continuous restraint applied to infants and toddlers with unilateral CP appeared to have a positive effect on paretic hand use in the real world.
Clinical Trial Registration Number:
NCT03418519.
