Adapted version of constraint-induced movement therapy promotes functioning in children with cerebral palsy: a randomized controlled trial.
OBJECTIVE
To evaluate the effects of constraint-induced movement therapy on the use of the affected arm and on daily functioning in children with hemiplegic cerebral palsy.


METHODS
A single-blinded randomized clinical trial.


METHODS
Sixteen children with cerebral palsy randomized to intervention (n = 8, 4 males, 4 females, mean age 5 years and 6 months) and control groups (n = 8, 4 males, 4 females, mean age 6 years and 7 months).


METHODS
Non-affected arm of intervention group was restricted for 10 hours/ day and the affected arm intensively trained for 3 hours/day for two weeks. The intervention protocol included one week of bimanual functional training following constraint therapy. The control group maintained usual rehabilitation throughout the intervention period.


METHODS
Pediatric Evaluation of Disability Inventory (self-care domain) and an adapted version of the Jebsen-Taylor test were administered before and after intervention, and at one month follow-up. General linear models tested differences in gain scores and the number needed to treat estimated relative effectiveness of intervention protocol for functional skills and independence in self-care.


RESULTS
Results are reported for 15 children who completed assessments and intervention. Higher gains were observed in the intervention group for functional skills and independence post intervention (d(functional skills) = 1.61, P =0.0134; d(independence)=1.37; P =0.0001) and follow-up (d(functional skills) = 2.08, P =0.004; d(independence) = 0.85; P =0.0016). No group difference in manual dexterity gains was observed. Low indices of number needed to treat (1.75 and 2.33) illustrate clinical relevance of intervention.


CONCLUSIONS
The protocol associating constraint-induced movement therapy and bimanual functional training was effective in promoting daily living functioning among children with cerebral palsy.
Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais.
Marina
M
de Brito Brandão
Marisa Cotta
MC
Mancini
Daniela Virgínia
DV
Vaz
Ana Paula
AP
Pereira de Melo
Sérgio Teixeira
ST
Fonseca
D000203:Activities of Daily Living / Q000523:psychology; D002547:Cerebral Palsy / Q000150:complications / Q000534:rehabilitation*; D002648:Child; D002675:Child, Preschool; D026241:Exercise Movement Techniques / Q000379:methods*; D005260:Female; D006429:Hemiplegia / Q000209:etiology / Q000534:rehabilitation; D006801:Humans; D008297:Male; D016037:Single-Blind Method; D011795:Surveys and Questionnaires