The pilot study of constraint induced movement therapy (CIMT) intervention in children with hemiplegic cerebral palsy after botulism toxin injection in preschool education

Abstract

The preschool intervention of CP children is important to facilitate hand function. Constraint induced movement therapy (CIMT) could facilitate hemiplegic hand function in CP children. Botulinum toxin was widely used to relieve spasticity. This study was designed to apply CIMT in children with hemiplegic CP after botulinum toxin injection in preschool education, and compared the effect and psychological stress between different programs. We recruited 4 CP children under regular botulism injection and randomized to 2 programs: –4 hours/day for 2 weeks; –2 hours/day for 4 weeks. The CIMT was performed one month after injection, and changed to another program after next injection. The outcome measurement included spasticity (MAS, MTS), Goal Attainment Scale (GAS), Peabody-Developmental Motor Scales (PDMS II) in grasp and Visual-motor integration (VMI), self-care of functional skill scale and self-care scale of care giver assistance in Chinese Version of Pediatric Evaluation of Disability Inventory (PEDI-C), anxiety and Oppositional Defiant Problems in Caregiver-Teacher Report Form (C-TRF) of Achenbach System of Empirically Based Assessment (ABEBA) before and after intervention, and every 2 months follow-up. The mean age was 5.42 years old, BMI was 15.8 and verbal IQ was 86. Grasp of PDMS and self-care of functional skill scale in PEDI-C were significant better after 2 hours/day-4 week program. The GAS, grasp, VMI and two self-care scales of PEDI were significant improved after CIMT, and continued improving until 4 months later, especially the GAS score. There was no difference of ABEBA between groups. The anxiety part was highest when just finished CIMT and the oppositional defiant problems were only different between finished CIMT and 2 months later. CIMT after Botox injection is effective to improve hand function and ADL in CP children, and the effect could continue 4 months. The 2 hours/day-4 week CIMT program might be better than 4 hours/day-2 week in self-care and grasp function.