Constraint-induced movement therapy (CIMT) for young children with cerebral palsy: effects of therapeutic dosage.
OBJECTIVE
To compare effects of 2 dosage levels of constraint-induced movement therapy (CIMT) for children with hemiplegic cerebral palsy (CP). We hypothesized that high-dosage CIMT would produce larger benefits than moderate-dosage.


METHODS
Three sites enrolled a total of 18 children (6 children per site from 3-6 years) with unilateral CP. Children were randomly assigned to CIMT for 21 days for either 6 hours/day (high-dosage=126 hours) or 3 hours/day (moderate-dosage=63 hours); both groups wore a long-arm cast. Evaluators (blind to dosage) assessed children 1-week prior, then 1-week and 1-month after treatment with the Assisting Hand Assessment (AHA), The Quality of Upper Extremity Skills Test (QUEST) Dissociated Movement and Grasp sections, the Shriners Hospital Upper Extremity Evaluation (SHUEE), and the Pediatric Motor Activity Log (PMAL).


RESULTS
All children responded well to casting and received the full intended dosage. Both groups showed statistically significant gains on the AHA, QUEST, SHUEE, and PMAL. Effect sizes ranged from 0.36-0.79. Overall, both groups showed comparable improvements at 1-week and 1-month post-treatment.


CONCLUSIONS
Pediatric CIMT at both moderate and high dosages produced positive effects across multiple reliable, valid outcome measures. The findings refuted the hypothesis of differential dosage benefits. Future research should address long-term effects, enroll larger and more diverse samples, and assess lower dosages to ascertain a minimal-efficacy threshold.
Department of Occupational Therapy, The University of Alabama, Birmingham, AL 35294, USA. sdeluca@uab.edu
Stephanie C
SC
DeLuca
Jane
J
Case-Smith
Richard
R
Stevenson
Sharon Landesman
SL
Ramey
D002547:Cerebral Palsy / Q000150:complications / Q000534:rehabilitation*; D002648:Child; D002675:Child, Preschool; D026241:Exercise Movement Techniques / Q000379:methods*; D005260:Female; D006429:Hemiplegia / Q000150:complications / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D009068:Movement; D015203:Reproducibility of Results; D012149:Restraint, Physical / Q000379:methods*; D016896:Treatment Outcome; D034941:Upper Extremity