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Constraint-induced movement therapy versus bimanual intensive therapy in children with hemiplegia showing low/very
Rocío Palomo-Carrión1, Asunción Ferri-Morales1, Sara Ando-LaFuente1
1University of Castilla-La Mancha, Toledo, Spain.
Insights
Modified constraint-induced movement therapy significantly improves upper limb function and quality of life in children with congenital hemiplegia. This therapy is more beneficial than bimanual intensive therapy for these children.
Area of Science:
- Pediatric rehabilitation
- Neurorehabilitation
- Occupational therapy
Background:
- Children with infantile hemiplegia often have limited use of their affected upper limb, impacting daily activities and quality of life.
- Low or very low bimanual functional performance presents significant challenges for these children.
Purpose of the Study:
- To evaluate the influence of the order and dosage of modified constraint-induced movement therapy within a hybrid protocol.
- To assess the impact on bimanual functional performance and quality of life in children with congenital hemiplegia (5-8 years old).
Main Methods:
- A single-blinded randomized controlled trial involving 21 children with congenital hemiplegia.
- Interventions included intensive therapies: modified constraint-induced movement therapy and bimanual intensive therapy over 10 weeks.
- Outcomes measured using the Assisting Hand Assessment and the Pediatric Quality of Life Inventory Cerebral-Palsy module.
Main Results:
- The experimental group showed a greater increase in bimanual functional performance (22 AHA units) with modified constraint-induced movement therapy.
- Quality of life improved most significantly after modified constraint-induced movement therapy (13.1 points in the experimental group).
- Protocol interaction was statistically significant for both bimanual functional performance (p=.018) and quality of life (p=.09).
Conclusions:
- Modified constraint-induced movement therapy demonstrates superior benefits compared to bimanual intensive therapy.
- This therapy enhances upper limb functioning and quality of life in children with congenital hemiplegia and low bimanual performance.
Introduction:
Children with infantile hemiplegia with low or very low bimanual functional performance have great impediments to spontaneously use their affected upper limb, which affects their performance of day-to-day activities and their quality of life.
Objective:
To determine whether the order of application and the dose of modified constraint-induced movement therapy within a combined (hybrid) protocol influences the results of bimanual functional performance of the affected upper limb and the quality of life of children with congenital hemiplegia (5 to 8 years old) with low/very low bimanual functional performance.
Design:
Single-blinded randomized controlled trial.
Participants:
Twenty-one children with congenital hemiplegia (5 to 8 years old) were recruited from two public hospitals and an infantile hemiplegia association in Spain.
Interventions:
The experimental group (n = 11) received 100 hours of intensive therapies for the affected upper limb: 80 hours of modified constraint-induced movement therapy and 20 hours of bimanual intensive therapy. The control group (n = 10) received the same dose with 80 hours of bimanual intensive therapy and 20 hours of modified constraint-induced movement therapy. The protocol was provided 2 hours per day, 5 days per week, for 10 weeks.
Outcome Measures:
The primary outcome was bimanual functional performance, measured with the Assisting Hand Assessment, and the second outcome was quality of life, measured with the Pediatric Quality of Life Inventory Cerebral-Palsy module (PedsQL v. 3.0, CP module). Four assessments were performed: Weeks 0, 4, 8, and 10.
Results:
The experimental group obtained an increase of 22 assisting hand assessment (AHA) units at week 8 with the application of modified constraint-induced movement, in contrast with the control group, which obtained an increase of 3.7 AHA units after bimanual intensive therapy. At week 10, the control group showed its greatest increase in bimanual functional performance, with 10.6 AHA units after modified constraint-induced movement therapy. Regarding quality of life, the greatest improvement occurred after modified constraint-induced movement, with 13.1 points in the experimental group (80 hours) and 6.3 points in the control group (20 hours). The protocol interaction was statistically significant for bimanual functional performance (p = .018) and quality of life (p = .09).
Conclusions:
Modified constraint-induced movement therapy is more beneficial than bimanual intensive therapy for improving upper limb functioning and quality of life in children with congenital hemiplegia showing low/very low bimanual performance.
Gov Identifier:
NCT03465046.
