title: Unimanual and bimanual intensive training in children with hemiplegic cerebral palsy and persistence in time of hand function improvement: 6-month follow-up results of a multisite clinical trial.
abstract: This study aims to compare in hemiplegic children the effectiveness of intensive training (unimanual and bimanual) versus standard treatment in improving hand function, assessing the persistence after 6 months. A multicenter, prospective, cluster-randomized controlled clinical trial was designed comparing 2 groups of children with hemiplegic cerebral palsy, treated for 10 weeks (3 h/d 7 d/wk; first with unimanual constraint-induced movement therapy, second with intensive bimanual training) with a standard treatment group. Children were assessed before and after treatment and at 3 and 6 months postintervention using Quality of Upper Extremity Skills Test (QUEST) and Besta Scales. One hundred five children were recruited (39 constraint-induced movement therapy, 33 intensive bimanual training, 33 standard treatment). Constraint-induced movement therapy and intensive bimanual training groups had significantly improved hand function, showing constant increase in time. Grasp improved immediately and significantly with constraint-induced movement therapy, and with bimanual training grasp improved gradually, reaching the same result. In both, spontaneous hand use increased in long-term assessment.
authors.affiliation: Division of Developmental Neurology, National Neurological Institute C. Besta, Milan, Italy.
authors.forename: Ermellina
authors.initials: E
authors.lastname: Fedrizzi
authors.forename: Melissa
authors.initials: M
authors.lastname: Rosa-Rizzotto
authors.forename: Anna Carla
authors.initials: AC
authors.lastname: Turconi
authors.forename: Emanuela
authors.initials: E
authors.lastname: Pagliano
authors.forename: Elisa
authors.initials: E
authors.lastname: Fazzi
authors.forename: Laura Visonà Dalla
authors.initials: LV
authors.lastname: Pozza
authors.forename: Paola
authors.initials: P
authors.lastname: Facchin
mesh_terms: D002547:Cerebral Palsy / Q000534:rehabilitation*; D002648:Child; D002675:Child, Preschool; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D007839:Functional Laterality / Q000502:physiology*; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D026741:Physical Therapy Modalities; D012149:Restraint, Physical / Q000379:methods*; D012720:Severity of Illness Index; D016037:Single-Blind Method; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D034941:Upper Extremity / Q000503:physiopathology*