The effectiveness of task-oriented intervention and trunk restraint on upper limb movement quality in children with cerebral palsy.
OBJECTIVE
The goal of this study was to contribute evidence towards the effectiveness of task-oriented training with and without restriction of trunk movement (trunk restraint) on the quality of upper limb movement in children with cerebral palsy (CP).


METHODS
We used a prospective, single-subject research design in 12 children (three males, nine females; aged 6-11 y; median 9 y) with di-, hemi-, or quadriplegia. Movements of the most affected arm were assessed five times: three times before training, immediately after training, and 3 months after training. The main outcome measures were the Melbourne Assessment of Unilateral Upper Limb Function (Melbourne) and upper limb movement kinematics during a functional reaching task. Children were randomly allocated to one of two groups: task-oriented training with or without trunk restraint. Treatment consisted of three 1-hour sessions per week for 5 weeks (total training duration 15 h). Treatment effects were determined using single-subject research design analysis--regression through baseline data and standard mean differences.


RESULTS
Although the Melbourne scores were largely unchanged after training, some children in each group improved arm trajectory smoothness (effect size 0.55-1.87), and most children improved elbow extension range (effect size 0.55-4.79). However, more children in the trunk restraint group than in the no restraint group demonstrated reduced trunk displacement (effect size 0.94-2.25) and longer-term improvements in elbow extension and trunk use. Among the group who underwent training without trunk restraint, trunk displacement was unchanged or increased, and fewer carry-over effects were apparent at follow-up.


CONCLUSIONS
This proof-of-principle study showed that greater improvement in the quality of upper limb movement in children with CP, including less compensatory trunk use and better carry-over effects, was achieved by training with trunk restraint.
Schneiberg
Sheila
S
Centre for Interdisciplinary Research in Rehabilitation (CRIR), Montreal, Canada.
McKinley
Patricia A
PA
Sveistrup
Heidi
H
Gisel
Erika
E
Mayo
Nancy E
NE
Levin
Mindy F
MF
D001696:Biomechanical Phenomena; D002547:Cerebral Palsy / Q000503:physiopathology* / Q000534:rehabilitation*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009068:Movement / Q000502:physiology*; D009949:Orientation / Q000502:physiology*; D055070:Resistance Training / Q000379:methods*; D016037:Single-Blind Method; D013647:Task Performance and Analysis; D034941:Upper Extremity / Q000503:physiopathology*