title: The influence of early modified constraint-induced movement therapy training on the longitudinal development of hand function in children with unilateral cerebral palsy.
abstract: OBJECTIVE
  There is evidence that modified constraint-induced movement therapy (mCIMT) has a short-term positive effect on hand function in children with unilateral cerebral palsy (CP), but the long-term effect is unknown. The aim of this study was to investigate whether or not a single block of mCIMT (2h/d for 2mo) at age 2 to 3 years influences the course of development of bimanual hand function at around 8 years of age.
  
  
  METHODS
  A convenience sample of 45 children (24 males, 21 females) with unilateral CP and mean (SD) age at first assessment 32 months (13mo) was included in this study. The participants were divided into the mCIMT group (n=26) and the reference group (no mCIMT; n=19). Brain lesion characteristics were available for 32 children. The children were measured repeatedly with the Assisting Hand Assessment (AHA) for a mean period of 4 years and 6 months. Development curves were created and compared with a non-linear mixed effects model.
  
  
  RESULTS
  Children who were receiving mCIMT had an upper limit of development of bimanual hand function that was 8.5 AHA units higher than in the reference group (p=0.022). However, when controlling for brain lesion characteristics and baseline in a subgroup of 32 children, the difference was considerably smaller and no longer significant.
  
  
  CONCLUSIONS
  mCIMT may have a positive impact on long-term development of bimanual hand function, but the results are inconclusive and further research is necessary.
authors.affiliation: Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Ann-Christin
authors.initials: AC
authors.lastname: Eliasson
authors.forename: Marie
authors.initials: M
authors.lastname: Holmefur
mesh_terms: D001930:Brain Injuries / Q000473:pathology*; D002547:Cerebral Palsy / Q000534:rehabilitation*; D002648:Child; D002675:Child, Preschool; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D007839:Functional Laterality / Q000502:physiology; D006225:Hand / Q000503:physiopathology*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009068:Movement / Q000502:physiology*; D012149:Restraint, Physical / Q000379:methods*; D016896:Treatment Outcome