Neuroradiology Can Predict the Development of Hand Function in Children With Unilateral Cerebral Palsy

Holmefur, Marie; Kits, Annika; Bergström, Jakob; Krumlinde‐Sundholm, Lena; Flodmark, Olof; Forssberg, Hans; Eliasson, Ann‐Christin

doi:10.1177/1545968312446950

Cited by 69 publications

(88 citation statements)

References 25 publications

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“…11 We have also previously shown that different brain lesion characteristics influence the typical limit of development of hand function as measured by the AHA at school age. 12 Among the brain abnormalities observed, children with white matter damage of immaturity (WMDI) had higher developmental limits than children with a middle cerebral artery (MCA) infarct. In other words, development was faster and a higher ability level was reached in those with WMDI.…”

Section: Resultsmentioning

confidence: 99%

“…This statistical model was also used in previous studies. 11,12 In this model, the development limit and rate are participant specific and included as random effects with a full variance-covariance structure (since limit and rate for a given participant may be correlated). The dependence between repeated measures on the same participant was assumed to be accounted for by the participant-specific parameters, i.e.…”

Section: Discussionmentioning

confidence: 99%

“…11,12 Further analyses were conducted in which the children were divided into two groups based on whether or not they had participated in an mCIMT programme.…”

Section: Methodsmentioning

confidence: 99%

“…Neuroimaging information on brain lesions was used for 32 children who have been previously described. 12 For further descriptive information see Table I.…”

Section: Participantsmentioning

confidence: 99%

“…The children had been included in previous studies describing longitudinal development. 11,12 All of the children had been involved in usual treatment before the data collection for this study. Twenty-six children had undergone one block of mCIMT 3,4 and 19 children participated as the reference group (i.e.…”

Section: Participantsmentioning

confidence: 99%

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The influence of early modified constraint‐induced movement therapy training on the longitudinal development of hand function in children with unilateral cerebral palsy

Eliasson

Holmefur

2014

Develop Med Child Neuro

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AHAAssisting Hand Assessment MCA Middle cerebral artery mCIMT Modified constraint-induced movement therapy WDMI White matter damage of immaturity AIM There is evidence that modified constraint-induced movement therapy (mCIMT) has a short-term positive effect on hand function in children with unilateral cerebral palsy (CP), but the long-term effect is unknown. The aim of this study was to investigate whether or not a single block of mCIMT (2h/d for 2mo) at age 2 to 3 years influences the course of development of bimanual hand function at around 8 years of age.METHOD A convenience sample of 45 children (24 males, 21 females) with unilateral CP and mean (SD) age at first assessment 32 months (13mo) was included in this study. The participants were divided into the mCIMT group (n=26) and the reference group (no mCIMT; n=19). Brain lesion characteristics were available for 32 children. The children were measured repeatedly with the Assisting Hand Assessment (AHA) for a mean period of 4 years and 6 months. Development curves were created and compared with a non-linear mixed effects model. RESULTSChildren who were receiving mCIMT had an upper limit of development of bimanual hand function that was 8.5 AHA units higher than in the reference group (p=0.022). However, when controlling for brain lesion characteristics and baseline in a subgroup of 32 children, the difference was considerably smaller and no longer significant.CONCLUSION mCIMT may have a positive impact on long-term development of bimanual hand function, but the results are inconclusive and further research is necessary.There is evidence from higher-level studies that modified constraint-induced movement therapy (mCIMT) is effective at improving hand function in children with unilateral cerebral palsy (CP). 1,2 The effect is maintained for at least 6 months after the therapy ends 3-7 and has been reported to last for up to 1 year. [8][9][10] Because the ultimate goal of treatment is to change the natural course of motor development in a lifetime perspective, it is important to investigate the long-term effect of mCIMT. 9The possible long-term impact of mCIMT is of great importance not only for children and their families, but also for health care providers when prioritizing and organizing resources. According to a recent consensus report, the long-term impact of this therapy has also been identified as one of the very important questions to explore in future research.9 Longer-term follow-up is complicated, however, because outcomes are susceptible to influences from other treatments and ongoing development. Further, it is questionable whether one block of mCIMT at an early age can be expected to have a notable impact after several years.We have previously shown that the Assisting Hand Assessment (AHA) measure at 18 months of age can predict both the rate and the ability limit of development. The most dramatic development of hand function occured in the early preschool period (before age 3y), at least in the case of the most able children, who spontaneously u...

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…11,12 Further analyses were conducted in which the children were divided into two groups based on whether or not they had participated in an mCIMT programme.…”

Section: Methodsmentioning

confidence: 99%

“…Neuroimaging information on brain lesions was used for 32 children who have been previously described. 12 For further descriptive information see Table I.…”

Section: Participantsmentioning

confidence: 99%