title: Muscle Recruitment and Coordination following Constraint-Induced Movement Therapy with Electrical Stimulation on Children with Hemiplegic Cerebral Palsy: A Randomized Controlled Trial.
abstract: OBJECTIVE
  To investigate changes of muscle recruitment and coordination following constraint-induced movement therapy, constraint-induced movement therapy plus electrical stimulation, and traditional occupational therapy in treating hand dysfunction.
  
  
  METHODS
  In a randomized, single-blind, controlled trial, children with hemiplegic cerebral palsy were randomly assigned to receive constraint-induced movement therapy (n = 22), constraint-induced movement therapy plus electrical stimulation (n = 23), or traditional occupational therapy (n = 23). Three groups received a 2-week hospital-based intervention and a 6-month home-based exercise program following hospital-based intervention. Constraint-induced movement therapy involved intensive functional training of the involved hand during which the uninvolved hand was constrained. Electrical stimulation was applied on wrist extensors of the involved hand. Traditional occupational therapy involved functional unimanual and bimanual training. All children underwent clinical assessments and surface electromyography (EMG) at baseline, 2 weeks, 3 and 6 months after treatment. Surface myoelectric signals were integrated EMG, root mean square and cocontraction ratio. Clinical measures were grip strength and upper extremity functional test.
  
  
  RESULTS
  Constraint-induced movement therapy plus electrical stimulation group showed both a greater rate of improvement in integrated EMG of the involved wrist extensors and cocontraction ratio compared to the other two groups at 3 and 6 months, as well as improving in root mean square of the involved wrist extensors than traditional occupational therapy group (p<0.05). Positive correlations were found between both upper extremity functional test scores and integrated EMG of the involved wrist as well as grip strength and integrated EMG of the involved wrist extensors (p<0.05).
  
  
  CONCLUSIONS
  Constraint-induced movement therapy plus electrical stimulation is likely to produce the best outcome in improving muscle recruitment and coordination in children with hemiplegic cerebral palsy compared to constraint-induced movement therapy alone or traditional occupational therapy.
  
  
  BACKGROUND
  chictr.org ChiCTR-TRC-13004041.
authors.affiliation: Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510120, China.
authors.forename: Kaishou
authors.initials: K
authors.lastname: Xu
authors.affiliation: Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510120, China.
authors.forename: Lu
authors.initials: L
authors.lastname: He
authors.affiliation: Department of Neurology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510120, China.
authors.forename: Jianning
authors.initials: J
authors.lastname: Mai
authors.affiliation: Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510120, China.
authors.forename: Xiaohua
authors.initials: X
authors.lastname: Yan
authors.affiliation: Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510120, China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002547:Cerebral Palsy / Q000473:pathology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D004558:Electric Stimulation; D004576:Electromyography; D006429:Hemiplegia / Q000628:therapy*; D006801:Humans; D008875:Middle Aged; D026741:Physical Therapy Modalities / Q000592:standards*; D016037:Single-Blind Method; D016896:Treatment Outcome; D034941:Upper Extremity / Q000473:pathology; D055815:Young Adult