title: Improvement of upper extremity motor control and function after home-based constraint induced therapy in children with unilateral cerebral palsy: immediate and long-term effects.
abstract: OBJECTIVE
  To investigate the long-term effects of home-based constraint induced therapy (CIT) on motor control underlying functional change in children with unilateral cerebral palsy (CP).
  
  
  METHODS
  Randomized controlled trial.
  
  
  METHODS
  Home based.
  
  
  METHODS
  Children with unilateral CP (N=45; aged 6-12 y) were randomly assigned to receive home-based CIT (n=23) or traditional rehabilitation (TR) (n=22).
  
  
  METHODS
  Both groups received a 4-week therapist-based intervention at home. The home-based CIT involved intensive functional training of the more affected upper extremity during which the less affected one was restrained. The TR involved functional unimanual and bimanual training.
  
  
  METHODS
  All children underwent kinematic and clinical assessments at baseline, 4 weeks (posttreatment), and 3 and 6 months (follow-up). The reach-to-grasp kinematics were reaction time (RT), normalized movement time, normalized movement unit, peak velocity (PV), maximum grip aperture (MGA), and percentage of movement where MGA occurs. The clinical measures were the Peabody Developmental Motor Scales, Second Edition (PDMS-2), Bruininks-Oseretsky Test of Motor Proficiency (BOTMP), and Functional Independence Measure for children (WeeFIM).
  
  
  RESULTS
  The home-based CIT group showed a shorter RT (P<.05) and normalized movement time (P<.01), smaller MGA (P=.006), and fewer normalized movement units (P=.014) in the reach-to-grasp movements at posttreatment and follow-up than the TR group. The home-based CIT group improved more on the PDMS-2 (P<.001) and WeeFIM (P<.01) in all posttreatment tests and on the BOTMP (P<.01) at follow-up than the TR group.
  
  
  CONCLUSIONS
  The home-based CIT induced better spatial and temporal efficiency (smoother movement, more efficient grasping, better movement preplanning and execution) for functional improvement up to 6 months after treatment than TR.
authors.affiliation: Department of Industrial Engineering and Management, National Taipei University of Technology, Taipei.
authors.forename: Hsieh-ching
authors.initials: HC
authors.lastname: Chen
authors.affiliation: Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou; Graduate Institute of Early Intervention, College of Medicine, Chang Gung University, Tao-Yuan. Electronic address: clingchen@gmail.com.
authors.forename: Chia-ling
authors.initials: CL
authors.lastname: Chen
authors.affiliation: Graduate Institute of Early Intervention, College of Medicine, Chang Gung University, Tao-Yuan.
authors.forename: Lin-ju
authors.initials: LJ
authors.lastname: Kang
authors.affiliation: Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, and Healthy Ageing Research Center at Chang Gung University, Taoyuan.
authors.forename: Ching-yi
authors.initials: CY
authors.lastname: Wu
authors.affiliation: Graduate Institute of Early Intervention, College of Medicine, Chang Gung University, Tao-Yuan; Department of Rehabilitation, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei.
authors.forename: Fei-chuan
authors.initials: FC
authors.lastname: Chen
authors.affiliation: Department of Sports Medicine, China Medical University, Taichung, Taiwan.
authors.forename: Wei-hsien
authors.initials: WH
authors.lastname: Hong
mesh_terms: D001696:Biomechanical Phenomena; D002547:Cerebral Palsy / Q000503:physiopathology* / Q000534:rehabilitation*; D002648:Child; D005260:Female; D006429:Hemiplegia / Q000503:physiopathology* / Q000534:rehabilitation*; D006699:Home Care Services; D006801:Humans; D008297:Male; D009068:Movement; D011597:Psychomotor Performance; D011930:Reaction Time; D012149:Restraint, Physical; D016037:Single-Blind Method; D013997:Time Factors; D034941:Upper Extremity / Q000503:physiopathology*
keywords: Cerebral palsy; Kinematics; Randomized controlled trial as topic; Rehabilitation