Constraint-Induced Movement Therapy in Obstetrical Brachial Plexus Palsy: A Single-Blind Pilot Randomized Controlled
Ana Carolina Rodrigues da Silva1, Rafael Santos Ferreira da Silva2, Heli de Oliveira Rodrigues1
1Pediatric Occupational Therapy Department, AACD, São Paulo, SP, Brazil.
Insights
Constraint-Induced Movement Therapy (CIMT) significantly improves arm function in children with Obstetrical Brachial Plexus Palsy (OBPP). CIMT demonstrated superior outcomes in movement quality, frequency, and motor program acquisition compared to conventional therapy.
Area of Science:
- Pediatric Rehabilitation
- Neurology
- Physical Therapy
Background:
- Obstetrical Brachial Plexus Palsy (OBPP) can impair upper limb function in children.
- Conventional therapies aim to improve motor skills but may have limitations.
Purpose of the Study:
- To compare the effectiveness of Constraint-Induced Movement Therapy (CIMT) against conventional therapy for children with OBPP.
- To assess improvements in arm usage frequency, quality, spontaneity, and new motor program acquisition.
Main Methods:
- A pilot randomized controlled trial was conducted with 20 children diagnosed with OBPP.
- Participants were assigned to either CIMT (intensive, 5x/week) or conventional therapy (2x/week).
- Evaluations included the Pediatric Mal Activity Log - Revised (PMAL-R), Pediatric Arm Function Test (PAFT), and Inventory of New Motor Activities and Programs (INMAP) pre- and post-treatment.
Main Results:
- CIMT showed significant superiority over the control group in improving movement frequency (p < 0.001) and quality (p < 0.001).
- Enhanced spontaneity of use in unimanual tasks was observed with CIMT (PAFT: p = 0.022).
- Significant gains in acquiring new motor programs were noted with CIMT (INMAP: p < 0.001), with large effect sizes.
Conclusions:
- Constraint-Induced Movement Therapy (CIMT) is more effective than standard care for children with OBPP.
- CIMT leads to substantial improvements in motor function, including movement quality, frequency, and the acquisition of new motor skills.
- The findings support CIMT as a preferred therapeutic approach for improving upper limb function in OBPP.
Aim:
To estimate the effectiveness of Constraint-Induced Movement Therapy (CIMT) vs. conventional therapy in improving the frequency, quality, and spontaneity of the affected arm usage and acquiring new motor programs in children with Obstetrical Brachial Plexus Palsy (OBPP).
Methods:
Pilot, randomized, and controlled clinical trial with a blind evaluator. Twenty (N = 20) children with OBPP diagnoses were divided into Intervention Group (CIMT protocol, 5x/week, 3h/day, 3 wk) and Control Group (conventional Physiotherapy/Occupational Therapy 2x/week, 40 min/day, 3 wk). Pediatric Mal Activity Log - Revised (PMAL-R) was used for quality and frequency measures; Pediatric Arm Function Test (PAFT) was used to measure the spontaneous use of the affected upper limb; Inventory of New Motor Activities and Programs (INMAP) was used for the acquisition of new motor programs. All the evaluations were applied pre and post treatment.
Results:
CIMT was superior compared to control in terms of frequency (mean change= 1.58; 95% CI 0.83 to 2.33; p < 0.001) and quality of movement (mean change= 1.53; 95% CI 0.78 to 2.28; p < 0.001), in spontaneity of use in unimanual tasks in PAFT (mean change= 2.9; 95% CI 1.29 to 4.5; p = 0.022) and in the INMAP (mean change= 1.4; 95% CI 0.70-2.10; p < 0.001). All the effect sizes for the differences were large, and MCID showed large effects for PMAL-R and PAFT.
Conclusion:
CIMT is favored over standard care, with gains in terms of quality and frequency of movement, spontaneity of use, and acquisition of motor programs.
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