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A Pilot Study of Two Different Constraint-Induced Movement Therapy Interventions in Children With Hemiplegic Cerebral
Chin-Lung Wu1, Su-Fen Liao2,3,4, Chi-Hsin Liu1
1Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, Changhua Christian Hospital, Changhua City, Taiwan.
Insights
This pilot study found that a 4-week constraint-induced movement therapy (CIMT) program improved hand function and self-care in children with hemiplegic cerebral palsy (CP) more effectively than a 2-week program after botulinum toxin (BoNT-A) injections.
Area of Science:
- Pediatric Rehabilitation
- Neurology
- Occupational Therapy
Background:
- Hemiplegic cerebral palsy (CP) affects motor function in children.
- Botulinum toxin type A (BoNT-A) injections are used to manage spasticity in CP.
- Constraint-induced movement therapy (CIMT) is a rehabilitation approach to improve upper limb function.
Purpose of the Study:
- To evaluate two low-dose (40-hour) CIMT interventions in preschool children with hemiplegic CP.
- To compare the effectiveness of a 2-week intensive versus a 4-week less intensive CIMT program.
- To assess CIMT's impact following BoNT-A injections on motor skills and daily function.
Main Methods:
- A pilot study involving five children with spastic CP (GMFCS levels I-II).
- Participants received two 40-hour CIMT programs (2-week/4-hours/day or 4-week/2-hours/day) after BoNT-A injections.
- Outcomes measured included Goal Attainment Scaling (GAS), Peabody-Developmental Motor Scales (PDMS), Functional Skill Scale, and Pediatric Evaluation of Disability Inventory (PEDI-C).
Main Results:
- The 4-week/2-hours/day CIMT program showed significant improvements in grasp, Visual-Motor Integration (VMI), and self-care (p < 0.001).
- GAS, grasp, VMI, and PEDI self-care scores improved significantly post-CIMT, with sustained benefits up to 4 months.
- No significant changes were observed in anxiety or oppositional defiance scores.
Conclusions:
- School-based CIMT following BoNT-A injections shows potential therapeutic benefits for children with hemiplegic CP.
- The 4-week/2-hours/day CIMT program appears more effective for self-care and hand function than the 2-week/4-hours/day program in this pilot.
- Future research should include larger sample sizes and blinded assessors for hand function and ADL evaluations.
Abstract:
Introduction: To establish a pilot study on applying two low dose (40 h) constraint-induced movement therapy (CIMT) interventions in children with hemiplegic cerebral palsy (CP) after botulinum toxin (BoNT-A) injection during preschool education. Methods: Five children with spastic CP (mean age: 5.31 years; Gross Motor Function Classification System level I and II) undergoing regular BoNT-A injections and rehabilitation programs were included. Participants were randomly allocated to one of two CIMT programs (40 h): a 2-week 4-hours/day CIMT program and a 4-week 2-hours/day CIMT program. One CIMT program was performed 1 month after a BoNT-A injection, and then the second program was implemented with the next injection. The outcomes were measured by changes in Goal Attainment Scaling (GAS), the grasp and Visual-Motor Integration (VMI) test in Peabody-Developmental Motor Scales (PDMS), the self-care scale on the Functional Skill Scale, and the Caregiver Assistance in Chinese Version of Pediatric Evaluation of Disability Inventory (PEDI-C), Anxiety and Oppositional Defiance Problems of Achenbach System of Empirically-Based Assessment before and after the CIMT interventions, and at every 2 months' follow-up thereafter. Results: The mean age of the participants was 5.31 years, BMI was 16.7 (kg/m2), VIQ was 86.4 ± 8.5, and dose of BoNT-A injection in the upper limb was 42 ± 26.6 units. Grasp, VMI, and self-care on the Functional Skill Scale were significantly better in the 4-week 2-hours/day CIMT program (p < 0.001, p = 0.001, p < 0.001). GAS, grasp, VMI, two 2 self-care scales of PEDI were significantly improved after the CIMT programs, and improvement continued for up to 4 months after the programs. There was no clinical evidence showing changes in the scores for anxiety and oppositional defiance problems during the study period. Conclusions: The preliminary findings, although limited, suggest a potential therapeutic role for the school-based CIMT program after BoNT-A injection. The 4-week 2-hours/day CIMT program might be better than a 2-week 4-hours/day program in terms of self-care and hand function when performed in kindergarten in this pilot study. Furthermore, this pilot study provides valuable information; therefore, it is crucial to include more CP children and blinded assessors for hand function and ADL in the future study.
