Efficacy of Constraint-Induced Movement Therapy on Involved Upper-Extremity Use in Children With Hemiplegic Cerebral Palsy Is Not Age-Dependent

Abstract

Constraint-induced (CI) movement therapy has been shown recently to be promising for improving upper-limb function in children with cerebral palsy (CP). Because little is known about patient characteristics predicting treatment efficacy, not all children may benefit from this intervention. Here we examine the relationship between efficacy of a child-friendly form of CI therapy and age on involved upper-extremity function. Twenty children with hemiplegic CP age 4 to 13 years received CI therapy and completed evaluations. Based on established functional and neuromaturational changes in hand skill development, the children were divided into a "younger group" (age 4-8 years, n = 12) and "older group" (age 9-13 years, n = 8). Children wore a sling on their noninvolved upper extremity for 6 hours per day for 10 of 12 consecutive days, during which time they were engaged in play and functional activities. Each child was evaluated by trained evaluators who were blinded to the fact that the children received treatment. The evaluations took place once before the intervention and at 1 week, 1 month, and 6 months after the intervention. Efficacy was examined at the movement efficiency (Jebsen-Taylor Test of Hand Function, subtest 8 of the Bruininks-Oseretsky Test of Motor Proficiency), environmental (caregiver frequency and quality of involved upper-limb use), and impairment (strength, tactile sensitivity, and muscle tone) levels. Children in both age groups had significant improvements in involved hand-movement efficiency and environmental functional limitations, which were retained through the 6-month posttest. However, there were no differences in efficacy between younger and older children. Both hand severity and the children's behavior during testing (number of redirections), with the latter serving as a reasonable correlate for attention during the intervention, were related to changes in performance in the younger group but not in the older group. The results suggest that the intensive practice associated with CI therapy can improve movement efficiency and environmental functional limitations among a carefully selected subgroup of children with hemiplegic CP of varying ages and that this efficacy is not age-dependent.