title: Best responders after intensive upper-limb training for children with unilateral cerebral palsy.
abstract: OBJECTIVE
  To delineate characteristics of best responders in a randomized trial comparing constraint-induced movement therapy (CIMT) to bimanual training for children with unilateral cerebral palsy.
  
  
  METHODS
  Secondary analysis of a single-blind matched-pairs randomized comparison trial.
  
  
  METHODS
  Community sporting facilities in 2 Australian capital cities.
  
  
  METHODS
  Children (n=64; mean age, 10.2±2.7y; 52% boys), matched for age, sex, side of hemiplegia, and upper-limb function, were randomized within pairs to CIMT or bimanual training. Sixty-one children who completed CIMT (n=31) or bimanual training (n=30) were included in this study.
  
  
  METHODS
  Each intervention was delivered in day camps (total 60h over 10d) using a novel circus theme with goal-directed training.
  
  
  METHODS
  Change between baseline, 3, and 26 weeks on the Melbourne Assessment of Unilateral Upper Limb Function (MUUL>7.4%), Assisting Hand Assessment (AHA>4 raw score points), and Canadian Occupational Performance Measure (COPM>2 points) defined best responders.
  
  
  RESULTS
  Poorer baseline hand function predicted a best response for unimanual capacity of the impaired upper limb (MUUL) immediately postintervention; however, at 26 weeks the odds of achieving a favorable outcome were 21 times greater for CIMT than bimanual training. A favorable response for bimanual performance (AHA) was predicted by immediate change in Jebsen-Taylor hand function test scores. Age (older), left-sided hemiplegia, and lower-baseline COPM performance scores significantly predicted favorable individualized outcomes.
  
  
  CONCLUSIONS
  Secondary analysis of a randomized trial directly comparing 2 upper-limb training models, found children with poorer hand function benefited most. Favorable outcomes for bimanual performance were associated with gains in movement efficiency and older children with left-sided hemiplegia achieved more favorable gains in perceived occupational performance.
authors: Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, Faculty of Health, The University of Queensland, Brisbane, Australia. leanne.sakzewski@uqconnect.edu.au
authors: Leanne
authors: L
authors: Sakzewski
authors: Jenny
authors: J
authors: Ziviani
authors: Roslyn N
authors: RN
authors: Boyd
mesh_terms: D001132:Arm / Q000503:physiopathology*; D002547:Cerebral Palsy / Q000503:physiopathology* / Q000534:rehabilitation*; D002648:Child; D004185:Disability Evaluation; D019988:Children with Disabilities / Q000534:rehabilitation*; D005260:Female; D006429:Hemiplegia / Q000503:physiopathology* / Q000534:rehabilitation*; D006801:Humans; D016015:Logistic Models; D008297:Male; D011793:Queensland; D012372:ROC Curve; D016037:Single-Blind Method; D016896:Treatment Outcome