Randomized Trial of Modified Constraint-Induced Movement Therapy With and Without an Intensive Therapy Program in Children With Unilateral Cerebral Palsy

Abstract

Background. Constraint-induced movement therapy (CIMT) has gained emerging evidence and popularity in children with unilateral cerebral palsy (CP). However, many issues remain unanswered regarding the best approach. Objective. This study investigated the additional effects of an intensive therapy program to promote hand function combined with home-based modified CIMT (m-CIMT). Methods. Fifty-one children (mean age 8 years 9 months) were randomized to m-CIMT alone or m-CIMT with intensive therapy (IT). All children had to wear a constraint on the unaffected hand for 1 hour, 5 days/week for 10 weeks. Children in the m-CIMT + IT group also received 3 sessions of 45 minutes weekly of intensive therapy for distal muscle strengthening and hand function, using unimanual and bimanual activities. The Assisting Hand Assessment (AHA) was the primary outcome measure. Secondary outcome measures were muscle tone, strength, Melbourne Assessment, Jebsen–Taylor test, and ABILHAND-Kids questionnaire. Assessments were administered at baseline, after intervention, and at 10-week follow-up. Results. Significant between-group differences in AHA were in favor of the m-CIMT + IT group (P = .04). Both groups demonstrated comparable improvements in muscle tone (P = .002), strength (P < .0001), grip strength (P = .02), and unimanual capacity (Melbourne Assessment and Jebsen–Taylor, P < .0001). Younger children and children with poorer hand function benefited from both interventions, whereas older children and children with better hand function only benefited from the combined approach. Conclusions. The combination of m-CIMT with an intensive therapy program on distal hand function and strength enhances the effects of m-CIMT alone for improving bimanual performance.