Home-based early intensive manual therapy in unilateral cerebral palsy under 2 years of age
Rocío Palomo-Carrión1,2,3, Elena Pinero-Pinto4,5, Cristina Lirio-Romero1,2,3
1Faculty of Physiotherapy and Nursing, Department of Nursing, Physiotherapy and Occupational Therapy, University of Castilla-La Mancha, UCLM, Toledo, Spain.
Insights
Early intensive home-based therapies significantly improved bimanual functional performance in infants with unilateral cerebral palsy (UCP). Therapies including modified Constraint-Induced Movement Therapy (mCIMT) showed the greatest gains in function and parent satisfaction.
Area of Science:
- Pediatric rehabilitation
- Neuroscience
- Developmental disorders
Background:
- Children with unilateral cerebral palsy (UCP) often exhibit "developmental disregard" of their affected upper limb.
- Early intervention during the critical window of neural plasticity (first 2 years) can enhance hand function and spontaneous use.
Purpose of the Study:
- To evaluate the effectiveness of home-based infant-intensive manual therapies for improving bimanual functional performance (BFP) in children with UCP aged 9-18 months.
- To compare these therapies against standard care.
Main Methods:
- A randomized controlled trial involved four groups: infant-mCIMT, InfantBIT, Infant-Hybrid (mCIMT + BIT), and Infant-standard-Therapy (control).
- Each intensive protocol comprised 50 hours over 10 weeks.
- Outcomes included BFP, functional goals, and parental satisfaction, assessed at baseline, 10 weeks, and 6 months post-treatment.
Main Results:
- All intensive therapy groups, except the control, demonstrated significant BFP increases post-therapy and at 6-month follow-up (p < 0.01).
- The greatest improvements in goal achievement and parent satisfaction were observed in groups incorporating mCIMT.
- Home-based intensive therapies led to greater BFP increases than conventional therapy.
Conclusions:
- Early intensive manual therapies, including infant-mCIMT, InfantBIT, and Infant-Hybrid, enhance BFP in infants with UCP, with sustained effects at 6 months.
- Infant-Hybrid therapy may offer superior functional improvements compared to mCIMT or BIT alone.
- High therapy intensity and family engagement in home-based programs are crucial for improving hand function.
Background:
Children with unilateral cerebral palsy (UCP) learn not to use their affected upper limb, which is known as "developmental disregard". Consequently, early intensive training could improve hand function, increasing spontaneous use for the first 2 years of life, where there is a great window for brain changes due to neural plasticity.
Objective:
To study the effectiveness of home-based infant-intensive manual therapies in facilitating bimanual functional performance (BFP) compared to standard care in children with UCP aged 9-18 months.
Methods:
A randomized controlled trial with single-blinded outcome assessment was conducted. Children were randomized into four groups: modified Constraint-Induced Movement Therapy for infants (infant-mCIMT), Bimanual Intensive Therapy for infants (InfantBIT), Hybrid Therapy, combining mCIMT and BIT, for infants (Infant-hybrid) and conventional therapy for children (Infant-standard-Therapy, control group-CG). Each early intensive protocol lasted 50 h and was applied throughout a 10-week period. The main outcomes were BFP, functional goals and parental satisfaction expectations regarding intensive manual therapy. Three measurements were performed (at Week 0, Week 10 and 6 months after treatment).
Results:
Forty infants aged 12.38 months (chronological age) met the inclusion criteria. All groups except CG showed significant increases in BFP after infant intensive manual therapy and at 6 months compared with the baseline assessment (p < 0.01). The greatest increases in goal achievement and parent satisfaction occurred in the groups that had an mCIMT component.
Conclusions:
Compared with standard therapy, early intensive manual therapies, i.e., infant-mCIMT, infant-BIT and infant-Hybrid therapy, resulted in greater increases in BFP and were maintained at the 6-month follow-up.
Clinical Trial Registration:
ClinicalTrials.gov: NCT06191588.
Impact:
Home-based early intensive manual therapies increase bimanual functional performance to a greater extent than conventional therapy. Infant-Hybrid therapy may result in greater improvements in functional bimanual performance compared to Infant-mCIMT or Infant-BIT alone. Higher therapy intensity and family involvement, particularly in home-based programs, are key factors for improving hand function compared to lower-dose, clinic-based usual care.
