Abstract
Children with hemiplegia have lower spontaneous use and quality of movement in the affected upper limb. The modified constraint-induced movement therapy (mCIMT) is applied to improve the affected upper limb function. The objective of this study was to study the efficacy of unaffected hand containment to obtain changes in the function of the affected upper limb after applying two unimanual therapies. A randomized controlled pilot study was performed with 16 children diagnosed with congenital infantile hemiplegia, with eight children randomized in each group (average age: 5.54 years; SD: 1.55). mCIMT and unimanual therapy without containment (UTWC) were applied, with a total of 50 h distributed in five weeks (two h/per day). Two assessments were performed (pre- and post-treatment) to evaluate the affected upper limb spontaneous use, measured with the Shiners Hospital Upper Extremity Evaluation (SHUEE), and the quality of movement, measured with the Quality of Upper Extremity Skills Test (QUEST scale). The progression of the variables was different in both groups. The results are expressed in the median of the improvement percent and interquartile range (IQR). The spontaneous use analysis showed an improvement percent of 31.65 (IQR: 2.33, 110.42) in the mCIMT group with respect to 0.00 (IQR: 0.00, 0.00) in the UTWC group. The quality of movement increased in the mCIMT and UTWC groups, 24.21 (IQR: 13.44, 50.39), 1.34 (IQR: 0.00, 4.75), respectively and the greatest increase was obtained in the grasp variable for both groups. The use of unaffected hand containment in mCIMT would produce improvements in the affected upper limb functionality in children with hemiplegia (4–8 years old) compared to the same protocol without containment (UTWC).
Highlights
Infantile cerebral palsy (ICP) is a non-progressive encephalopathy that produces a series of permanent disorders, affecting motor and postural development in children [1]
These differences were present in the modified constraint-induced movement therapy (mCIMT) group, with respect to the UWTC group, since spontaneous use analysis (SUA) showed an improvement percent of 31.65 (IQR: 2.33, 110.42) in the mCIMT group with respect to 0.00 (IQR: 0.00, 0.00) in the unimanual therapy without containment (UTWC) group
These differences were present in the mCIMT group, with respect to the UWTC group, since the movement quality (MQ) showed an improvement percent of 24.21 (IQR: 13.44, 50.39) in the mCIMT group with respect to 1.34 (IQR: 0.00, 4.75) in the UTWC group
Summary
Infantile cerebral palsy (ICP) is a non-progressive encephalopathy that produces a series of permanent disorders, affecting motor and postural development in children [1]. Movements in the affected upper limb are slower and clumsy and accompanied by mirror movements. There is a reduction in the use of the affected hand, commonly known as “developmental disregard”, which interferes with activities of daily living [3]. Children with hemiplegia do not acquire a typical movement experience in their affected upper limb, unlike adults who have suffered a stroke later in their lifetime. The therapy used must provide the opportunity to experiment with the affected side, granting as much functionality as possible to the affected upper limb [4]
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