title: Intensive upper limb intervention with self-management training is feasible and promising for older children and adolescents with unilateral cerebral palsy.
abstract: This study explored the feasibility and preliminary effectiveness of a short (one week) intensive intervention combining Constraint Induced Movement Therapy (CIMT) and bimanual training (BiT) to improve upper limb capacity and bimanual performance guided by individual goal setting in children and adolescents with unilateral cerebral palsy aged 8-18 years. Self-management training was added to the intervention to maximize the effect of training and to empower the participants in self-monitoring the effective use of their affected hand. Functional goals (Canadian Occupational Performance Measure), unimanual capacity (Box and Block Test), bimanual performance (ABILHAND-Kids, Children's Hand-use Experience Questionnaire (CHEQ)) and amount of use (Video Observation Aarts and Aarts - determine developmental disregard (VOAA-DDD-R)) were measured at baseline, one week and four months post intervention. Twenty children (mean age 9.5 years) participated. Repeated measures ANOVA was used to measure effects over time. Compared to baseline, there were significant improvements on all outcome measures. The largest effect sizes were found for the COPM-performance and COPM-satisfaction (Cohen's d=2.09 and d=2.42, respectively). The effect size was large for the ABILHAND-Kids (d=0.86), moderate for the CHEQ (d=0.70) and Box and Block Test (d=0.56), and small for the VOAA-DDD-R (d=0.33). All effects were retained at the four months post intervention assessment. The results of this study indicate that one-week (36h) intensive CIMT-BiT combined with self-management training is a feasible and promising intervention for improving the capacity of the upper limb and its use in bimanual activities in older children and adolescents with unilateral CP.
authors.affiliation: Department of Pediatric Rehabilitation, Sint Maartenskliniek, Postbus 9011, 6500 GM Nijmegen, The Netherlands. Electronic address: y.geerdink@maartenskliniek.nl.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Geerdink
authors.affiliation: Department of Pediatric Rehabilitation, Sint Maartenskliniek, Postbus 9011, 6500 GM Nijmegen, The Netherlands. Electronic address: p.aarts@maartenskliniek.nl.
authors.forename: Pauline
authors.initials: P
authors.lastname: Aarts
authors.affiliation: Department of Pediatric Rehabilitation, Sint Maartenskliniek, Postbus 9011, 6500 GM Nijmegen, The Netherlands. Electronic address: j.vanderburg@maartenskliniek.nl.
authors.forename: Jan
authors.initials: J
authors.lastname: van der Burg
authors.affiliation: Radboud University, Behavioural Science Institute, Postbus 9104, 6500 HE Nijmegen, The Netherlands; Australian Catholic University, School of Psychology, Melbourne, Australia. Electronic address: b.steenbergen@pwo.ru.nl.
authors.forename: Bert
authors.initials: B
authors.lastname: Steenbergen
authors.affiliation: Radboud University Medical Centre, Donders Centre for Neuroscience (DCN), Department of Rehabilitation, 898, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands. Electronic address: sander.geurts@radboudumc.nl.
authors.forename: Alexander
authors.initials: A
authors.lastname: Geurts
mesh_terms: D000293:Adolescent; D002547:Cerebral Palsy / Q000534:rehabilitation*; D002648:Child; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D026741:Physical Therapy Modalities; D012149:Restraint, Physical / Q000379:methods; D012648:Self Care / Q000379:methods*; D016896:Treatment Outcome; D034941:Upper Extremity
keywords: Bimanual training; Constraint Induced Movement Therapy; Self-management training; Unilateral cerebral palsy; Upper limb training