Modified Constraint-Induced Movement Therapy combined with Bimanual Training (mCIMT–BiT) in children with unilateral spastic cerebral palsy: How are improvements in arm-hand use established?

Constraint-induced movement therapy of upper limb of children with cerebral palsy in clinical practice: systematic review of the literature

“…Aarts PB et al 18 "Capacity" and "performance" scores on VOAA-DDD increased, whereas "development" score remained stable in CIMT-BT group; No improvement in scores of Control group after intervention, but improvement in "performance" at follow-up; No significant improvements in active or passive range of motion in either group…”

“…CIMT was not employed in its classic form and was modified with respect to the constraint method, duration of constraint (days or weeks), type and duration of therapy, intervention setting (home, school or clinic) and intervention provider (therapist, parent or teacher). The first significant variant was the method employed to constrain the unaffected limb, for which a range of techniques was used, such as a mitt 21,22,[24][25][26]28 , sling [17][18][19][20] , cast 27 and splint…”

“…In two clinical trials conducted by Aarts et al 17,18 , the treatment group submitted to CIMT received more sessions per week and more hours per session than the control group, but the individuals in the control group complemented their training at home to match the total number of hours to which the treatment group was submitted. Choudhary et al 23 conducted interventions on ten days distributed over a four-week period, in which the treatment group received two hours per day at a rehabilitation center, and the control group received 20 minutes a day at home.…”

“…For the functional classification of individuals eligible for inclusion in the study, the Manual Abilities Classification System (MACS) was used in two studies 17,18 , which was developed to categorize, respectively, the mobility and manual function of children with CP 31,32 . Other studies included in this review used the results of the Quality of Upper Extremity Skills Test (QUEST), Pediatric Motor Activity Log (PMAL) and Jebsen-Taylor Hand Function Test ( JTHF) as part of the inclusion criteria 19,[22][23][24] .…”

“…In 9 of the 12 clinical trials [17][18][19][20]22,23,[25][26][27] , difficulties and dropouts occurred due to family problems, scheduling problems, changes of address and a lack of transportation. In the study by Sakzewski et al 26 , nine of the participants dropped out of the study groups and a seizure occurred in one child during treatment; however, the authors did not describe the dropouts in detail.…”