[The effectiveness of constraint-induced movement therapy for children with hemiplegia following acquired brain injury].
Constraint-induced movement therapy is a promising technique for improving upper limb function in adults with hemiplegia. It involves restraint of the non-involved limb and intensive movement practice with the paretic limb. Although the technique has been applied successfully to children with cerebral palsy, only two studies have used it in children with acquired brain injury.


OBJECTIVE
To assess the feasibility and efficacy of constraint-induced movement therapy in children with acquired brain injury.


METHODS
We used a single-subject experimental design in three children (aged five at the time of the intervention) with hemiplegia in the chronic phase following acquired brain injury. The intervention involved restraint of the unaffected arm with a Mayo Clinic elbow brace for seven hours a day in a hospital setting, together with three hours a day of physical and occupational therapy rehabilitation for five days a week for two weeks. The children were assessed twice at baseline and then once immediately post-treatment and again two months post-treatment. Assessment included a range of timed, quantitative measures of upper limb use, assessment of unilateral spatial neglect and qualitative assessment by therapists and parents in terms of activities of daily living.


RESULTS
The three children completed the full protocol and improved significantly in all timed, quantitative tests of motor function. These improvements were partially maintained at two months. No improvement in unilateral spatial neglect was found in the paper-and-pencil tasks, although less spatial neglect was observed in activities of daily living such as eating and walking.


CONCLUSIONS
Constraint-induced movement therapy appears to be both feasible and efficient in children with acquired brain injury.
Chevignard
M
M
Service de rééducation des pathologies neurologiques acquises de l'enfant, hôpital national de Saint-Maurice, 14, rue du Val-d'Osne, 94410 Saint Maurice, France. m.chevignard@hopital-saint-maurice.fr
Azzi
V
V
Abada
G
G
Lemesle
C
C
Bur
S
S
Toure
H
H
Brugel
D G
DG
Laurent-Vannier
A
A
D001930:Brain Injuries / Q000150:complications*; D002675:Child, Preschool; D005240:Feasibility Studies; D006429:Hemiplegia / Q000209:etiology / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D009788:Occupational Therapy / Q000379:methods*; D026741:Physical Therapy Modalities; D012149:Restraint, Physical