Abstract
Objective:This study aims at determining the effectiveness of constraint induced movement therapy as compared to bimanual therapy for improving functional status in children with hemiplegic cerebral palsy.Methods:This study was a randomized control trial, children (n = 20) with spastic hemiplegic cerebral palsy was randomly allocated to CIMT (constraint induced movement therapy) and BMT (bimanual therapy) group. The children with spastic hemiplegia, age between 1.5 and 12 year and having 10 degrees of wrist extension and 10 degrees of finger extension were included in study. Treatment regime was two hours of daily training six days a week for two weeks. Constraint was applied to CIMT group for six hours. The outcome tool QUEST was used for baseline and post treatment assessment.Result:CIMT had superior outcome as compared to BMT in improving functional status (p=0.007). On QUEST tool grasp and dissociated movements results were significant (p=0.005) and (p=0.028) respectively. Weight bearing and protective extension resulted in no significant outcome (p=0.080) and (p=0.149) respectively. Dissociated movements and grasp are significantly improved but there is no difference for weight bearing and protective extension in CIMT treated group as compared to BMT treated group.Conclusion:CIMT approach is better in improving functional status of child with cerebral palsy as compared to BMT. Significant improvement in grasp and dissociated movement is noted in group of CIMT while there was no significant improvement in weight bearing and protective extension in CIMT group when compared to BMT. CIMT is considered the appropriate treatment approach for unilateral conditions while BMT for bilateral conditions.
Highlights
Cerebral palsy is defined as “a group of permanent disorders of the development of movement and posture, causing activity limitations, which are attributed to non-progressive disturbances that occurred in the developing fetal or infant brain”
Dissociated movements and grasp are significantly improved in constraint induced movement therapy (CIMT) treated group as compared to BMT treated group
There is no difference for weight bearing and protective extension in both groups
Summary
Cerebral palsy is defined as “a group of permanent disorders of the development of movement and posture, causing activity limitations, which are attributed to non-progressive disturbances that occurred in the developing fetal or infant brain”. The motor disorders of cerebral palsy are often accompanied by disturbances of sensation, perception, cognition, communication, and behavior and by secondary musculoskeletal problem”.1. There are different risk factor associated with the cerebral palsy after birth including of low APGAR score, less weighed placenta, respiratory problems, infection and seizures in neonates.[2] In literature there are multiple types of CP according to the nature of injury and area of involvement, it involves posture and movement impairment of cerebral origin, hemiplegic cerebral palsy being one of many of its types. The rehabilitation of cerebral palsy is always a challenging for professionals and different therapies are listed in literature which follows multiple theoretical framework. The learned non use that occurs by insult to the central nervous system, CIMT is directed to treat it by increasing the use of affected limb in functional activities called massed practice and constraining the less affected limb.[3]
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