title: The state of the evidence for intensive upper limb therapy approaches for children with unilateral cerebral palsy.
abstract: Children with unilateral cerebral palsy experience difficulties with unimanual and bimanual upper limb function, impacting independence in daily life. Targeted upper limb therapies such as constraint-induced movement therapy, bimanual training, and combined approaches have emerged in the last decade. This article reviews the scientific rationale underpinning these treatments and current evidence to improve upper limb outcomes and goal attainment. Intensive models of therapy achieved modest to strong effects to improve upper limb function compared to usual care. Dose-matched comparisons of bimanual and unimanual training demonstrated similar gains in upper limb outcomes. The optimum timing, dose and impact of repeat episodes of intensive upper limb therapies require further investigation. Characteristics of children who achieve clinically meaningful outcomes remain unclear. Key components of intervention include collaborative goal setting with families and intensive repetitive, incrementally challenging, task practice. Choice of treatment approach should be governed by child/family goals and preferences, individual, and contextual factors.
authors.affiliation: Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, University of Queensland, Queensland, Australia l.sakzewski1@uq.edu.au.
authors.forename: Leanne
authors.initials: L
authors.lastname: Sakzewski
authors.affiliation: Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Gordon
authors.affiliation: Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Ann-Christin
authors.initials: AC
authors.lastname: Eliasson
mesh_terms: D002547:Cerebral Palsy / Q000503:physiopathology* / Q000534:rehabilitation*; D002648:Child; D005081:Exercise Therapy / Q000379:methods*; D007839:Functional Laterality / Q000502:physiology*; D006801:Humans; D010807:Physical Endurance; D034941:Upper Extremity / Q000503:physiopathology*
keywords: constraint-induced movement therapy; efficacy; hand arm–intensive bimanual training; hemiplegia; review