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Constraint-Induced Movement Therapy for Cerebral Palsy: A Randomized Trial
Sharon Landesman Ramey1, Stephanie C DeLuca2, Richard D Stevenson3
1Fralin Biomedical Research Institute, Virginia Tech, Blacksburg, Virginia slramey@vt.edu.
Insights
High-dose constraint-induced movement therapy (CIMT) in children with hemiparetic cerebral palsy consistently showed the greatest improvements in arm and hand function. All CIMT interventions improved parent-reported functioning more than usual care.
Area of Science:
- Pediatric Rehabilitation
- Neurology
- Physical Therapy
Background:
- Hemiparetic cerebral palsy (CP) significantly impacts upper extremity function in children.
- Constraint-Induced Movement Therapy (CIMT) is a potential intervention, but optimal dosage and constraint type require investigation.
Purpose of the Study:
- To compare different doses and constraint types of CIMT against usual customary treatment (UCT) in children with hemiparetic CP.
- To evaluate the efficacy of CIMT on motor skills and daily functioning.
Main Methods:
- The Children with Hemiparesis Arm and Hand Movement Project (CHAMP) trial randomized 118 children (2-8 years) with hemiparetic CP to 5 treatment arms.
- Assessments included blinded outcomes (Assisting Hand Assessment, Peabody, Quality of UE Skills Test) and parent-reported measures (PEDI-CAT, Child Motor Activity Log).
- Analyses focused on blinded outcomes, parent reports, and rank-order gains at baseline, end of treatment, and 6 months posttreatment.
Main Results:
- High-dose CIMT consistently yielded the greatest short- and long-term gains across multiple measures, with significant improvements in visual motor integration and dissociated movement at 6 months.
- Rank-order analyses confirmed high-dose CIMT superior to moderate dose and UCT.
- All CIMT groups showed significantly greater improvements in parent-reported functioning compared to UCT, with objective gains also observed.
Conclusions:
- High-dose CIMT, irrespective of constraint type, demonstrates superior efficacy in improving upper extremity function and daily activities in children with hemiparetic CP.
- While individual blinded outcomes showed variability, consistent trends support high-dose CIMT.
- Unexpected improvements in UCT suggest potential for increased dosage in standard care.
Objectives:
With the Children with Hemiparesis Arm and Hand Movement Project (CHAMP) multisite factorial randomized controlled trial, we compared 2 doses and 2 constraint types of constraint-induced movement therapy (CIMT) to usual customary treatment (UCT).
Methods:
CHAMP randomly assigned 118 2- to 8-year-olds with hemiparetic cerebral palsy to one of 5 treatments with assessments at baseline, end of treatment, and 6 months posttreatment. Primary blinded outcomes were the assisting hand assessment; Peabody Motor Development Scales, Second Edition, Visual Motor Integration; and Quality of Upper Extremity Skills Test Dissociated Movement. Parents rated functioning on the Pediatric Evaluation of Disabilities Inventory-Computer Adaptive Test Daily Activities and Child Motor Activity Log How Often scale. Analyses were focused on blinded and parent-report outcomes and rank-order gains across all measures.
Results:
Findings varied in statistical significance when analyzing individual blinded outcomes. parent reports, and rank-order gains. Consistently, high-dose CIMT, regardless of constraint type, produced a pattern of greatest short- and long-term gains (1.7% probability of occurring by chance alone) and significant gains on visual motor integration and dissociated movement at 6 months. O'Brien's rank-order analyses revealed high-dose CIMT produced significantly greater improvement than a moderate dose or UCT. All CIMT groups improved significantly more in parent-reported functioning, compared with that of UCT. Children with UCT also revealed objective gains (eg, 48% exceeded the smallest-detectable assisting hand assessment change, compared with 71% high-dose CIMT at the end of treatment).
Conclusions:
CHAMP provides novel albeit complex findings: although most individual blinded outcomes fell below statistical significance for group differences, high-dose CIMT consistently produced the largest improvements at both time points. An unexpected finding concerns shifts in UCT toward higher dosages, with improved outcomes compared with previous reports.
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