Effects of combining constraint-induced movement therapy and action-observation training on upper limb kinematics in children with unilateral cerebral palsy: a randomized controlled trial

Lisa Mailleux,Hilde Feys,Kaat Desloovere,Els Ortibus,Katrijn Klingels,Cristina Simon-Martinez,Ellen Jaspers

doi:10.1038/s41598-020-67427-2

Abstract

Modified constraint-induced movement therapy (mCIMT) improves upper limb (UL) motor execution in unilateral cerebral palsy (uCP). As these children also show motor planning deficits, action-observation training (AOT) might be of additional value. Here, we investigated the combined value of AOT to mCIMT on UL kinematics in children with uCP in a randomized controlled trial. Thirty-six children with uCP completed an UL kinematic and clinical evaluation after participating in a 9-day mCIMT camp wearing a splint for 6 h/day. The experimental group (mCIMT + AOT, n = 20) received 15 h of AOT, i.e. video-observation and execution of unimanual tasks. The control group (mCIMT + placebo, n = 16) watched biological-motion free videos and executed the same tasks. We examined changes in motor control (movement duration, peak velocity, time-to-peak velocity, and trajectory straightness) and kinematic movement patterns (using Statistical Parametric Mapping) during the execution of three unimanual, relevant tasks before the intervention, after and at 6 months follow-up. Adding AOT to mCIMT mainly affected movement duration during reaching, whereas little benefit is seen on UL movement patterns. mCIMT, with or without AOT, improved peak velocity and trajectory straightness, and proximal movement patterns. Clinical and kinematic improvements are poorly related. Although there seem to be limited benefits of AOT to CIMT on UL kinematics, our results support the inclusion of kinematics to capture changes in motor control and movement patterns of the proximal joints.

Highlights

Modified constraint-induced movement therapy improves upper limb (UL) motor execution in unilateral cerebral palsy
Three-dimensional motion analysis (3DMA) provides a quantitative measurement of UL kinematics of proximal and distal joints[21,22,23], highlighting its added value compared to clinical scales24. 3DMA has shown that children with unilateral cerebral palsy (uCP) perform unimanual tasks with longer duration, lower and earlier peak velocity, and with a less straight trajectory[21] and with aberrant movement patterns at all levels of the UL chain[21,25], compared to typically developing children
Forty-four children with uCP participated in this study (mean age (SD) 9y6m (1y10m); 27 boys; 9 MACS I, 15 MACS II, 20 MACS III), and were randomized into the Modified constraint-induced movement therapy (mCIMT) + actionobservation training (AOT) (n = 22) and the mCIMT + placebo (n = 22)

Summary

Introduction

Modified constraint-induced movement therapy (mCIMT) improves upper limb (UL) motor execution in unilateral cerebral palsy (uCP). As these children show motor planning deficits, actionobservation training (AOT) might be of additional value. Apart from motor execution problems, children with uCP may have difficulties in motor representation and motor p lanning[11,12] These deficits can be targeted with Action-Observation Training (AOT), a novel. Three-dimensional motion analysis (3DMA) provides a quantitative measurement of UL kinematics (spatiotemporal characteristics and joint angles, indicative of motor control and movement patterns) of proximal and distal joints[21,22,23], highlighting its added value compared to clinical scales. Treatmentinduced changes of UL movement pathology require a comprehensive analysis over the entire waveform of the joint angle, and the use of SPM1d on 3DMA data will potentially enable us to capture changes in movement patterns after an intensive training

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