Does well-functioning hand constraint induce stress in forced-use therapy for children with unilateral cerebral
Eun Jae Ko1, In Young Sung2, Jin Sook Yuk3
1Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan.
Insights
Forced-use therapy (FUT) using hand constraint improved upper limb function in children with unilateral spastic cerebral palsy. This intervention did not cause emotional or behavioral issues, showing it
Area of Science:
- Pediatric Rehabilitation
- Neuroscience
- Developmental Pediatrics
Background:
- Unilateral spastic cerebral palsy (CP) affects upper limb function in children.
- Forced-use therapy (FUT) is a common intervention, but its impact on child stress requires investigation.
Purpose of the Study:
- To assess the stress levels induced by FUT with well-functioning hand constraint in children with unilateral spastic CP.
- To evaluate the effects of FUT on upper limb function and daily living activities.
Main Methods:
- Seventeen children with unilateral spastic CP underwent 4-week FUT with unaffected upper limb immobilization.
- Assessments included behavioral checklists (K-CBCL), upper limb function tests (BBT, EDPA, QUEST, PMAL), and daily activity measures (PEDI).
- Evaluations were conducted pre-treatment, immediately post-treatment, and at 6-month follow-up.
Main Results:
- While preschooler stress scores showed a tendency to increase, and school-aged children's scores tended to decrease, no significant changes in K-CBCL scales were observed.
- Significant improvements were noted in Box and Block Test, Quality of Upper Extremity Skill Test, and Pediatric Motor Activity Log (how often and well subscales).
- No significant emotional or behavioral problems were induced by the FUT intervention.
Conclusions:
- Four-week FUT with well-functioning hand constraint is effective in improving upper limb function in children with unilateral spastic CP.
- This therapeutic approach appears safe regarding emotional and behavioral well-being.
- FUT is a viable treatment option for enhancing motor skills in pediatric CP populations.
Abstract:
This study investigated the stress induced by well-functioning hand constraint in forced-use therapy (FUT) for children with unilateral spastic cerebral palsy (CP).Seventeen children with unilateral spastic CP (mean age 5.8 years) received FUT: 4-week unaffected upper limb immobilization with a short-arm Scotchcast and were encouraged to incorporate it to their daily routines and plays. They were evaluated at pretreatment, immediate post-treatment, and 6 months post-treatment. The Korea-Child Behavior Checklist (K-CBCL) was used to assess the stress degree; box and block test (BBT), Erhardt Developmental Prehension Assessment (EDPA), Quality of Upper Extremity Skill Test (QUEST), and Pediatric Motor Activity Log (PMAL), upper limb function; and Pediatric Evaluation of Disability Inventory (PEDI), daily living activities.In the preschoolers, most scores of K-CBCL tended to increase after FUT; however, there was no significant change in all scale findings after FUT. In the school-aged children, most scores of K-CBCL tended to decrease after FUT; however, there was no significant change in all scale findings after FUT. The findings of the BBT, QUEST, PMAL how often and well subscales significantly improved post-treatment (P < .05).The 4-week FUT with well-functioning hand constraint significantly improved the UL function and did not induce emotional and behavioral problems in children with unilateral spastic CP.
