Multicenter Randomized Controlled Trial of Pediatric Constraint-Induced Movement Therapy: 6-Month Follow-Up

Abstract

OBJECTIVE. Pediatric constraint-induced movement therapy (CIMT) is a promising intervention for children with unilateral cerebral palsy (CP). This multisite randomized controlled trial (RCT) tested the hypothesis that 6 hr versus 3 hr per day for 21 days would produce larger maintenance of gains 6 mo posttreatment. METHOD. Three sites recruited 18 children (6 per site) ages 3–6 yr with unilateral CP. Children were randomly assigned to 3 or 6 hr/day of CIMT for 21 days and wore a cast on the unaffected extremity the first 18 days. Occupational therapists applied a standardized pediatric CIMT protocol. Evaluators blinded to condition administered the Assisted Hand Assessment and the Quality of Upper Extremity Skills Test, and parents completed the Pediatric Motor Activity Log pre- and posttreatment (1 wk, 1 mo, and 6 mo). RESULTS. Both CIMT dosage groups showed significant gains on all five assessments with no significant group differences at 6-mo follow-up. Effect sizes (n = 15) comparing preintervention to postintervention measures (partial η2) ranged from .33 to .80. CONCLUSION. This first multisite RCT of pediatric CIMT confirmed the maintenance of positive effects at 6 mo follow-up across multiple functional performance measures. The hypothesis that maintenance of effects would differ for children who received 6 versus 3 hr/day of CIMT (126 vs. 63 total hr) was not supported.

Efficacy of Upper Limb Therapies for Unilateral Cerebral Palsy: A Meta-analysis

“…Thirteen types of UL interventions and numbers of participants were identified: NDT (2 studies; n = 122), 12,13 intramuscular injections of BoNT-A and OT (11 studies; n = 322), [14][15][16][17][18][19][20][21][22][23][24] cCIMT (3 studies; n = 56), 6,[25][26][27][28] mCIMT (15 studies; n = 578), 7,[29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47] hybrid model (mCIMT and bimanual training; 2 studies; n = 68), 8,9 forced-use therapy (2 studies; n = 54), 48,49 HABIT (1 study; n = 20), 50 OT home programs (1 study; n = 35), 51 UL lycra splints (1 study; n = 16), 52 contextfocused therapy (1 study; n = 128), 53 mirror box therapy (1 study; n = 10), 54 acupuncture combined with OT (1 study; n = 75), …”

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

“…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…”

“…Case-Smith J et al 27 Significant improvements in AHA, PMAL and movement dissociation (QUEST) in both groups…”

“…Secondly, the treatment programs varied the intensity, ranging from 4 weeks of intervention distributed in 10 days, 2 hours a day, totaling 20 hours of intervention 23 for 4 weeks, distributed in 21 days, 6 hours per session, totaling 126 hours of intervention 27 . The fact that the frequency, intensity and duration varied among the trials analyzed in the present review limits the development of guidelines regarding these aspects in interventions involving CIMT for children with CP.…”

“…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.…”