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Constraint-induced movement therapy for children with neonatal brachial plexus palsy: a randomized crossover trial
Julie M Werner1,2, Jamie Berggren2, Jennifer Loiselle2
1Institute for Nursing and Interprofessional Research, Children's Hospital Los Angeles, Los Angeles, CA, USA.
Insights
Constraint-induced movement therapy (CIMT) significantly improved bimanual activity performance in children with neonatal brachial plexus palsy (NBPP) compared to standard care. This therapy offers a promising approach for enhancing upper-limb function.
Area of Science:
- Pediatric rehabilitation
- Neurology
- Occupational therapy
Background:
- Neonatal brachial plexus palsy (NBPP) affects upper-limb function in infants.
- Standard care for NBPP has varying outcomes.
- Constraint-induced movement therapy (CIMT) is a potential intervention.
Purpose of the Study:
- To compare the effectiveness of CIMT versus standard care for improving upper-limb activity in children with NBPP.
- To assess bimanual activity performance and caregiver-reported outcomes.
Main Methods:
- A crossover trial involving 21 children with NBPP.
- Participants received either CIMT or standard care for 8 weeks.
- The Assisting Hand Assessment (AHA) and Pediatric Motor Activity Log-Revised (PMAL-R) were used for outcome measurement.
Main Results:
- CIMT demonstrated superior bimanual activity performance compared to standard care (mean AHA difference: 4.8, p=0.04).
- No significant differences were found in caregiver-reported outcomes (PMAL-R).
- Improvements in bimanual activity were greater with CIMT.
Conclusions:
- CIMT is favored over standard care for enhancing bimanual activity performance in children with NBPP.
- Further research is recommended to explore longer follow-up periods and different interventions.
Aim:
To determine if constraint-induced movement therapy (CIMT) is more effective than standard care in improving upper-limb activity outcomes in children with neonatal brachial plexus palsy (NBPP).
Method:
Twenty-one children with NBPP (mean age 25mo, SD=10.3, range=17-48mo; 11 males, 10 females) were enrolled in a crossover trial and randomly allocated to first receive CIMT or standard care, each for 8 weeks. The intervention arm consisted of 3 weeks of casting the unaffected limb followed by 5 weeks of transference activities. The Assisting Hand Assessment (AHA) was used to measure bimanual activity performance at baseline, 8 weeks, and 16 weeks, scored by blinded raters. The Pediatric Motor Activity Log-Revised (PMAL-R) was used as a caregiver-reported secondary outcome measure.
Results:
After concealed random allocation (n=21), there were no significant differences on demographics or baseline measures. CIMT was superior compared to control in terms of bimanual activity performance with a mean difference in AHA change score of 4.8 (SD=10.5, p=0.04, Cohen's δ=0.46). There were no significant differences between treatment conditions on the PMAL-R.
Interpretation:
CIMT is favored over standard care for bimanual activity performance. Future research should investigate a longer follow-up period, additional comparator interventions, and analyse differences by participant characteristics.
What This Paper Adds:
Gains in bimanual activity performance were greater after constraint-induced movement therapy (CIMT) compared to no CIMT. Frequency and quality of movement were not significantly different between treatment groups.
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