Constraint-induced movement therapy improves upper limb activity and participation in hemiplegic cerebral palsy: a systematic review.
OBJECTIVE
Does constraint-induced movement therapy improve activity and participation in children with hemiplegic cerebral palsy? Does it improve activity and participation more than the same dose of upper limb therapy without restraint? Is the effect of constraint-induced movement therapy related to the duration of intervention or the age of the children?


METHODS
Systematic review of randomised trials with meta-analysis.


METHODS
Children with hemiplegic cerebral palsy with any level of motor disability.


METHODS
The experimental group received constraint-induced movement therapy (defined as restraint of the less affected upper limb during supervised activity practice of the more affected upper limb). The control group received no intervention, sham intervention, or the same dose of upper limb therapy.


METHODS
Measures of upper limb activity and participation were used in the analysis.


RESULTS
Constraint-induced movement therapy was more effective than no/sham intervention in terms of upper limb activity (SMD 0.63, 95% CI 0.20 to 1.06) and participation (SMD 1.21, 95% CI 0.41 to 2.02). However, constraint-induced movement therapy was no better than the same dose of upper limb therapy without restraint either in terms of upper limb activity (SMD 0.05, 95% CI -0.21 to 0.32) or participation (SMD -0.02, 95% CI -0.34 to 0.31). The effect of constraint-induced movement therapy was not related to the duration of intervention or the age of the children.


CONCLUSIONS
This review suggests that constraint-induced movement therapy is more effective than no intervention, but no more effective than the same dose of upper limb practice without restraint.


BACKGROUND
PROSPERO CRD42015024665. [Chiu H-C, Ada L (2016) Constraint-induced movement therapy improves upper limb activity and participation in hemiplegic cerebral palsy: a systematic review.Journal of Physiotherapy62: 130-137].
Department of Physical Therapy, I-Shou University, Kaohsiung, Taiwan (ROC).
Hsiu-Ching
HC
Chiu
Discipline of Physiotherapy,The University of Sydney, Sydney, Australia.
Louise
L
Ada
D002547:Cerebral Palsy / Q000503:physiopathology / Q000534:rehabilitation*; D005081:Exercise Therapy / Q000379:methods*; D006801:Humans; D016896:Treatment Outcome; D034941:Upper Extremity / Q000503:physiopathology*
Cerebral palsy; Constraint-induced movement therapy; Meta-analysis; Randomised controlled trials; Systematic review