Constraint-induced movement therapy in children with unilateral cerebral palsy

Hoare, Brian; Wallen, Margaret; Thorley, Megan; Jackman, Michelle; Carey, Leeanne; Imms, Christine

doi:10.1002/14651858.cd004149.pub3

Cited by 97 publications

(152 citation statements)

References 322 publications

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“…We extracted data from known valid and reliable outcome measures in the CP population, as per the work of Hoare and colleagues (Hoare et al., 2019). Quantitative data were extracted for the following outcome measures: AHA, Quality of Upper Extremity Skills Test (QUEST), Melbourne Assessment 2, The Box and Blocks Test, Abilhand‐Kids, COPM, The Goal Attainment Scale (GAS), the Pediatric Evaluation of Disability Inventory (PEDI), and the Functional Independence Measure for children (WeeFIM).…”

Section: Methodsmentioning

confidence: 99%

What is the threshold dose of upper limb training for children with cerebral palsy to improve function? A systematic review

Jackman

Lannin

Galea

et al. 2020

Aus Occup Therapy J

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Introduction Neuroplasticity is harnessed through high‐intensity or high‐dose training. Given the costs and time burden for families of children with cerebral palsy (CP), it is important to quantify which rehabilitation training approaches and doses confer the largest clinical gain. The main objective of this systematic review was to determine any threshold dose of upper limb training needed for children with CP to achieve clinically significant functional improvements. Methods This systematic review included studies if they were as follows: randomised controlled trials; participants had a diagnosis of CP or brain injury; mean age of participants was 0–18 years; and intervention was an active upper limb training intervention. Two raters independently extracted data. Data were pooled and analysed using a receiver operator characteristic (ROC) curve and odds ratios to investigate the dose of practice that led to clinically significant gains. Results A total of 74 trials were included in this review. Quantitative analyses included 25 studies (707 participants; age range 18 months to 21 years) for motor function (Assisting Hand Assessment) and 20 studies (491 participants; age range 3 months to 17 years) for individual goal achievement (Canadian Occupational Performance Measure). ROC curve analyses found that approximately 40 hr of practice is needed to improve upper limb motor ability in the unilateral population. For all typographies of CP, individual goals were achieved at a lower dose (14–25 hr) of practice when goal‐directed interventions were provided. Conclusion To improve individual goals, children need to practice goals for more than 14–25 hr, combining face‐to‐face therapy with home practice. To improve general upper limb function (based on evidence in the unilateral population), children need to practice for more than 30–40 hr. Interventions that set functional goals and involve actual practice of those goals lead to goal achievement at a lower dose than general upper limb motor training.

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Section: Methodsmentioning

confidence: 99%

What is the threshold dose of upper limb training for children with cerebral palsy to improve function? A systematic review

Jackman

Lannin

Galea

et al. 2020

Aus Occup Therapy J

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“…This decline in severity is encouraging. Children with cerebral palsy may be more likely than ever to be treatment responsive to motor [20,21], bimanual training [54][55][56], constraintinduced movement therapy [46,[62][63][64][65][66][67], functional chewing training [137], goal-directed training [98], home programs using goal-directed training [112], mobility training [123,127], treadmill training [65,123,127], partial body weight support treadmill training [123,127,169], and occupational therapy post botulinum toxin [190] (green lights). Moreover, environmental enrichment to promote task performance is effective (green light) [95] and adapting the environment and task to enable task performance via context-focused therapy (yellow light) [77] is a potent modulator of effective care.…”

Section: Motor Interventionsmentioning

confidence: 99%

State of the Evidence Traffic Lights 2019: Systematic Review of Interventions for Preventing and Treating Children with Cerebral Palsy

Novak

Morgan

Fahey

et al. 2020

Curr Neurol Neurosci Rep

663

611

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Purpose of Review Cerebral palsy is the most common physical disability of childhood, but the rate is falling, and severity is lessening. We conducted a systematic overview of best available evidence (2012-2019), appraising evidence using GRADE and the Evidence Alert Traffic Light System and then aggregated the new findings with our previous 2013 findings. This article summarizes the best available evidence interventions for preventing and managing cerebral palsy in 2019. Recent Findings Effective prevention strategies include antenatal corticosteroids, magnesium sulfate, caffeine, and neonatal hypothermia. Effective allied health interventions include acceptance and commitment therapy, action observations, bimanual training, casting, constraint-induced movement therapy, environmental enrichment, fitness training, goal-directed training, hippotherapy, home programs, literacy interventions, mobility training, oral sensorimotor, oral sensorimotor plus electrical stimulation, pressure care, stepping stones triple P, strength training, task-specific training, treadmill training, partial body weight support treadmill training, and weight-bearing. Effective medical and surgical interventions include anti-convulsants, bisphosphonates, botulinum toxin, botulinum toxin plus occupational therapy, botulinum toxin plus casting, diazepam, dentistry, hip surveillance, intrathecal baclofen, scoliosis correction, selective dorsal rhizotomy, and umbilical cord blood cell therapy. Summary We have provided guidance about what works and what does not to inform decision-making, and highlighted areas for more research.

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“…Particular attention is directed towards intensive treatments; they are developing rapidly and are supported by a growing amount of evidence, indicating that therapies of higher intensity are more effective. A Cochrane review on constraint-induced movement therapy indicates that this intensive intervention is more effective for improving unimanual hand functions than a low-intensity alternative [5]. A quasi-randomized trial of the intensive upper and lower extremity training providing 6.5 intensive intervention hours per day over 13 consecutive days reports significant improvement in gross and fine motor functions in children with bilateral CP [6].…”

Section: оригінальні дослідження /Original Researches/mentioning

confidence: 99%

Зміни рухових функцій у дітей iз церебральним паралічем після курсу інтенсивної нейрофізіологічної реабілітації: сліпе дослідження

Kachmar¹,

Mysula²,

Kushnir³

et al. 2021

INJ

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Background. Modern intensive interventions addressing multiple challenges in children with cerebral palsy are attracting clinicians' and researchers' attention. One of such methods is the intensive neurophysiological rehabilitation system (INRS)-a combination of interventions focusing on different functional goals, merged into one intensive course. The purpose of the study was to assess changes in gross motor functions, muscle spasticity and passive range of motion (PROM) in children with spastic forms of cerebral palsy (CP) after the two-week of treatment course with INRS. Materials and methods. A single-arm, single-blind pre-post study was conducted among 57 children aged 4 to 12 years with spastic CP, admitted for treatment to the tertiary care center. Patients were examined before and after the two-week course using INRS, which included multiple interventions totalling 4-5 hours of treatment daily. The Gross Motor Function Measure-66 (GMFM-66) tasks were video-recorded and evaluated independently by two investigators. The time of recordings (baseline or post-intervention) was masked. PROM in the lower extremity joints was assessed with a manual goniometer, muscle spasticity-with the Modified Ashworth scale. Results. GMFM-66 scores after INRS use increased statistically significantly from 58.8 to 60.2 points, with a mean difference of 1.4 ± 2.9 points. Substantial improvement in PROM was noted for 5 of 7 movements; the most substantial improvement was observed in hip abduction-an average of 8.0 ± 5.8° and foot dorsiflexion-8.0 ± 6.1°. Reduction of the muscle tone was observed in all measured muscle groups. Statistically significant decrease of spasticity was noted in hip flexors, with an average reduction of 0.25 scale steps (95% confidence interval (CI) = 0.06-0.44), and hip adductors-0.30 steps (95% CI = 0.08-0.51). Conclusions. Improvements of gross motor functions, an increase of PROM in the lower extremities and reduction of muscle spasticity have been detected after the two-week course with INRS. Intensive treatment using INRS requires further studies, including randomized controlled ones.

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Constraint-induced movement therapy in children with unilateral cerebral palsy

Abstract: Constraint-induced movement therapy in children with unilateral cerebral palsy (Review)

Cited by 97 publications

References 322 publications

What is the threshold dose of upper limb training for children with cerebral palsy to improve function? A systematic review

What is the threshold dose of upper limb training for children with cerebral palsy to improve function? A systematic review

State of the Evidence Traffic Lights 2019: Systematic Review of Interventions for Preventing and Treating Children with Cerebral Palsy

Зміни рухових функцій у дітей iз церебральним паралічем після курсу інтенсивної нейрофізіологічної реабілітації: сліпе дослідження

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