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Development of Hand Use with and Without Intensive Training Among Children with Unilateral Cerebral Palsy in
Gunvor L Klevberg1, Manuela Zucknick2, Reidun Jahnsen1,3
1Department of Neurosciences in Children, Norwegian Quality and Surveillance Registry for Cerebral Palsy (NorCP), Oslo University Hospital, Oslo, Norway.
Insights
Constraint-Induced Movement Therapy (CIMT) improved hand use development in children with unilateral cerebral palsy. Early intervention with Baby-CIMT may further enhance developmental outcomes.
Area of Science:
- Pediatric rehabilitation
- Neurodevelopmental disorders
- Occupational therapy
Background:
- Unilateral cerebral palsy (UCP) significantly impacts hand function development.
- Constraint-Induced Movement Therapy (CIMT) is a common intervention for UCP.
- Understanding the long-term effects of CIMT and early interventions is crucial.
Purpose of the Study:
- To describe and compare hand use development in children with UCP based on participation in CIMT before age 7.
- To evaluate the impact of different CIMT protocols (CIMT and Baby-CIMT) on developmental trajectories.
Main Methods:
- A cohort of 334 children with UCP (18 months–12 years) was analyzed.
- 1,565 Assisting Hand Assessments (AHAs) were used to measure hand function.
- Participants were categorized into no intensive training (NIT), CIMT (18 months–7 years), and Baby-CIMT (<18 months) groups.
Main Results:
- Assisting Hand Assessment at 18 months (AHA-18) positively correlated with development across all groups.
- The CIMT group showed a longer developmental window, reaching 90% of development at a later age compared to the NIT group.
- While not statistically significant, the Baby-CIMT group demonstrated a trend towards higher developmental curves.
Conclusions:
- Constraint-Induced Movement Therapy (CIMT) enhances hand use development over time in children with UCP.
- Intensive training, including CIMT, extends the developmental period for hand function.
- Baby-CIMT shows potential for promoting earlier hand function development.
Aim:
To describe hand use development in children with unilateral cerebral palsy who did/did not participate in constraint-induced movement therapy (CIMT) before 7 years of age.
Method:
The study included 334 participants (18 months-12 years) who were assessed with 1,565 Assisting Hand Assessments (AHAs) and categorized into no intensive training (NIT), CIMT (18 months-7 years), and Baby-CIMT (<18 months) groups.
Results:
AHA performance at 18 months (AHA-18) was positively associated with development regardless of training. The CIMT group had lower AHA-18 performance than the NIT group (p = .028), but higher stable limit (p = .076). The age when 90% of development was reached was highest in the CIMT group (p = .014). Although non-significant, the Baby-CIMT group had higher mean curve than NIT and CIMT combined (AHA-18 p = .459, limit p = .477).
Conclusion:
The CIMT group improved more over time than the NIT group. Intensive training extended the window of development, and Baby-CIMT might promote early development.
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