Effectiveness of modified constraint-induced movement therapy in children with unilateral spastic cerebral palsy: a randomized controlled trial.
BACKGROUND
In children with unilateral spastic cerebral palsy (CP), there is only limited evidence for the effectiveness of modified constraint-induced movement therapy (mCIMT).


OBJECTIVE
To investigate whether 6 weeks of mCIMT followed by 2 weeks of bimanual task-specific training (mCIMT-BiT) in children with unilateral spastic CP improves the spontaneous use of the affected limb in both qualitative and quantitative terms more than usual care (UC) of the same duration.


METHODS
Children with unilateral spastic CP with Manual Ability Classification System (MACS) scores I, II, or III and aged 2.5 to 8 years were recruited and randomly allocated to either the mCIMT-BiT group (three 3-hour sessions per week: 6 weeks of mCIMT, followed by 2 weeks of task-specific training in goal-directed bimanual play and self-care activities) or to 1.5 hours of more general physical or occupational weekly plus encouragement to use the affected hand for the UC group. Primary outcome measures were the Assisting Hand Assessment and the ABILHAND-Kids. Secondary outcomes were the Melbourne Assessment of Unilateral Upper Limb Function, the Canadian Occupational Performance Measure, and the Goal Attainment Scale.


RESULTS
Twenty-eight children were allocated to mCIMT-BiT and 24 to UC. Except for the Melbourne, all primary and secondary outcome measures demonstrated significant improvements in the mCIMT-BiT group.


CONCLUSIONS
mCIMT followed by task-specific training of goal-directed bimanual play and self-care activities is an effective intervention to improve the spontaneous use of the more affected upper limb in children with relatively good baseline upper extremity function.
Aarts
Pauline B
PB
Sint Maartenskliniek, Nijmegen, Netherlands. p.aarts@maartenskliniek.nl
Jongerius
Peter H
PH
Geerdink
Yvonne A
YA
van Limbeek
Jacques
J
Geurts
Alexander C
AC
D001132:Arm / Q000294:innervation / Q000503:physiopathology; D002547:Cerebral Palsy / Q000503:physiopathology / Q000628:therapy*; D002675:Child, Preschool; D005081:Exercise Therapy / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D008297:Male; D009068:Movement / Q000502:physiology*; D018482:Muscle, Skeletal / Q000294:innervation / Q000503:physiopathology; D017063:Outcome Assessment, Health Care; D026741:Physical Therapy Modalities; D012149:Restraint, Physical / Q000379:methods*; D016896:Treatment Outcome