Hand Functions Following Prone-weight Bearing on Upper Limb with Active Elbow Extension Versus Modified Constraint
Amitesh Narayan1, Ruth Bavighar1, Shyam Krishnan1
1Department of Physiotherapy, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Karnataka, Manipal, 576 104, India.
Insights
Static weight bearing (SWB) in prone position improved hand functions in children with unilateral cerebral palsy (UCP) more than modified-constrained induced movement therapy (m-CIMT). SWB enhances grasping and prehension skills, offering a superior therapeutic approach for UCP hand function.
Area of Science:
- Pediatric Rehabilitation
- Neuroscience
- Occupational Therapy
Background:
- Unilateral cerebral palsy (UCP) in children often presents with atypical upper limb (UL) flexion patterns, hindering natural weight-bearing and hand function.
- Current therapeutic strategies for improving hand function in UCP lack standardization, despite documented benefits of UL weight-bearing.
- Restricted mobility and reduced hand dexterity are significant challenges for children with UCP.
Purpose of the Study:
- To compare the efficacy of Static weight bearing (SWB) in prone with active elbow extension against modified-constrained induced movement therapy (m-CIMT) for enhancing hand functions in children with UCP.
- To evaluate the impact of SWB and m-CIMT on specific hand function subtests in pediatric UCP patients.
Main Methods:
- A randomized clinical trial involving 38 children with UCP, equally divided into two groups: SWB (n=19) and m-CIMT (n=19).
- Intervention duration was two weeks, with outcome assessment using the Peabody Developmental Motor Scales-2 (PDMS-2) Fine Motor subtest (FM_PDMS-2).
- Pre- and post-intervention assessments measured changes in grasping and VMI (Visual-Motor Integration) skills.
Main Results:
- Both SWB and m-CIMT interventions resulted in statistically significant improvements in hand functions (p < 0.000).
- The SWB group exhibited greater percentage changes in both Grasping (37.67%) and VMI (14.11%) subtests compared to the m-CIMT group (12.78% and 4.88%, respectively).
- These findings indicate a more pronounced positive effect of SWB on hand function recovery.
Conclusions:
- Both SWB and m-CIMT are effective in improving hand functions in children with UCP.
- Static weight bearing (SWB) demonstrates superior efficacy over m-CIMT in enhancing grasping and prehension skills, as measured by the FM_PDMS-2.
- SWB represents a promising therapeutic intervention for improving upper limb and hand function in pediatric UCP populations.
Abstract:
BackgroundThe atypical upper limb (UL) flexion pattern in children with unilateral cerebral palsy (UCP) debilitates their ability to experience natural weight bearing through arms and hands, leading to restricted mobility and reduced hand functions. The recommended therapeutic strategies to improve hand functions are not standardized, i.e., (varied protocols, treatment schedules, and frequency), though the benefits of UL weight-bearing on hand-opening and prehension skills are well-documented.ObjectiveTo study the efficacy of Static weight bearing (SWB) in Prone on UL with active elbow extension versus modified-constrained induced movement therapy (m-CIMT) on hand functions in children with UCP.MethodsRandomized clinical trial. Subjects (N = 38) were randomized equally (group- 1, SWB, n = 19; and group- 2, m-CIMT, n = 19). Outcome measure- Fine Motor of PDMS-2 (FM_PDMS-2) pre-and post-interventions after 2 weeks.ResultsThe percentage change (post-intervention) for the Grasping and VMI subtests in the SWB group were 37.67% and 14.11%, while for the m-CIMT group were 12.78% and 4.88%, respectively. These changes were highly significant (p 0.000).ConclusionBoth groups, i.e., SWB and m-CIMT, showed significant differences in the percentage change post-intervention. However, the SWB group demonstrated augmented changes over the m-CIMT on both subtests of FM_PDMS-2, hence greater improvement in hand functions following SWB exercises.
