Induced Movement Therapy Research Articles

Poster 407: Sensory Recovery After Constraint Induced Movement Therapy: A Case Report

Poster 407: Sensory Recovery After Constraint Induced Movement Therapy: A Case Report

Sensory recovery after constraint – induced movement therapy

Constraint-Induced Movement Therapy (CIMT) involves intensive training of the affected arm, restraining of the less affected arm (immobilization) and shaping techniques. Previous reports have documented CIMT's clinical efficacy and its reorganization model. Since previous studies focused on motor recovery alone, it is still now unclear whether motor improvement is also based on sensory recovery. In former clinical studies subgroups of patients with sensory deficits showed more improvement of motor tests than patients with less affected sensory deficits. Considering this circumstance the underlying reorganization pattern is unclear by now. The aim of the current study was to investigate reorganization within the sensory network before and after CIMT. 7 chronic stroke patients with moderate hemiparesis and sensory deficits (no anaesthesia) were included to the study. CIMT contained six hours daily intensive training over two weeks with shaping technique and immobilization of the less affected arm. Motor tests (Wolf Motor Function Test, WMFT and Motor Activity Log, MAL) and fMRI were performed before and after CIMT. Passive movement of the affected and less affected hand was used to activate the sensory network. All patients improved their hand function significantly after CIMT. A correlation analysis between functional activation during passive hand movement of the affected hand and WMFT revealed a close relationship. This analysis showed that improvement of hand function was accompanied with less S1 activation and more thalamus activation. We suggest that functional interaction between S1 and thalamus plays an important role in hand function improvement after CIMT. In a post hoc analysis, probabilistic fiber tracking was used to connect two seed points between S1 and thalamus. Reorganization of improved hand function after CIMT is not only limited to the motor network, but also is based on reorganization within the sensory network.

체성운동영역이 제거된 편마비 흰쥐에서 억제 유도치료가 기능향상과 BDNF 발현에 미치는 효과

억제유도치료는 건측 상지의 운동을 제한하고 환측 상지의 운동을 유도함으로써 손상된 상지의 기능 및 사용을 향상시키는 치료이다. 본 연구의 목적은 동물모델을 이용하여 억제유도치료의 효과를 운동행동검사와 면역조직 화학법으로 검증하기 위함이다. 본 연구에서는 Sprague-Dawley계 흰쥐 수컷 실험군 40마리 대조군 40마리를 사용하였다. 실험동물은 마취 후 체성운동영역을 제거하여 억제유도치료를 적용한 실험군과 적용하지 않은 대조군으로 나누었다. 실험동물은 수술 후 1일, 3일, 7일, 14일째 10마리씩 나누어 자세 반사 검사, 막대 걷기 검사, 앞다리 배치 검사, 면역조직 화학반응을 실시하였다. 결과는 실험군의 운동행동 검사에서 모두 유의하게 높았고(p<.05), BDNF 발현은 시간이 지날수록 실험군의 발현량이 높게 나타났다. 이와 같은 결과는 중추신경계의 가소성을 검증 하는데 기여하리라 생각된다. CIMT(Constraint Induced Movement Therapy) is to improve the function and use of damaged upper limbs by not only confinement of unaffected limbs' exercise but also inducement of affected limbs' one. The purpose of the study is to verify the effect of CIMT by means of motor behaviour test and immunohistochemistry, using animal models. This study was analyzed using 40 male Sprague-Dawley rats as the experimental groups and 40 ones as the control groups. The rats were divided into two random groups : one group as an experimental group which was operated on under anesthesia and removed somatomotor regions with CIMT and the other as the control group without CIMT.Postural Reflex Test, Beam Walking Test, Limb Placement Test and Immunohistochemistry were run on the day 1, 3 , 7 and day 14 following surgery to each 10 rat. As a result, this study demonstrates that CIMT might be an effect method to verify the plasticity of central nervous system as motor behaviour test made all high scores (p<.05) and BDNF was high too in experimental groups.

A guide to physiotherapy in cerebral palsy

This review aims to elucidate current thinking and physiotherapy practice in the treatment and management of children with cerebral palsy (CP). It discusses established approaches to treatment, such as Bobath/NDT, conductive education and sensory integration, commonly used by therapist to address the problems seen in children with CP. The review also explores interventions that are currently advocated for the treatment of specific groups of people with CP, including constraint induced movement therapy, partial body weight-supported treadmill training and strength-training programmes.

Neuroplasticity after Constraint Induced Movement Therapy: Patients with ipsilateral cortico-spinal organisation

Neuroplasticity after Constraint Induced Movement Therapy: Patients with ipsilateral cortico-spinal organisation

Neuroplasticity after constraint induced movement therapy: Patients with ipsilateral cortico-spinal organisation

Objective: Constraint-Induced Movement Therapy (CIMT) is a functional approach focussing on hand motor improvement in hemiparetic patients. Here, we describe neuroplastic effects after two weeks of CIMT in patients with ipsilateral cortico-spinal (re-)organization.

Modification of Constraint Induced Movement Therapy in the Home Health Setting for a Subject with Chronic Hemiparesis after Stroke

Constraint induced movement therapy (CIMT) has been found to be beneficial in upper extremity recovery of patients following a stroke. However, its feasibility in the home health setting has not been assessed. This prospective case study describes changes in upper extremity function with a modification of CIMT administered in the home health setting. The participant was an 83-year-old man 6 months post-stroke with left sided hemiparesis resulting from a right ischemic stroke. The residual left-sided weakness was complicated by pre-existing left shoulder pain due to osteoarthritis. He had not been able to return to many of his household chores and hobbies following the stroke. The intervention consisted of 1 hour functional task practice sessions in the participant's home 3 days each week for 5 weeks. A restraint of the less-affected arm was used for 5 hours each day during the intervention period. Activities that required use of the left upper extremity alone and activities that required the use of both upper extremities were included. Primary outcome measures used before and after the intervention included the Motor Activity Log (MAL) and the Wolf Motor Function Test (WMFT). Improvements were noted in both the MAL and WMFT following the intervention. The participant increased his ability to perform functional activities and household chores. The supervised practice of functional tasks in the participant's home provides a clinically-relevant option for home-based physical therapy of the geriatric patient with stroke. This case study showed that the modified CIMT was feasible in the home setting for our participant. Further research on CIMT interventions in the home setting should include repeated baseline measurements and a larger number of subjects.

Outcomes 12 months after a constraint induced movement therapy program were maintained for an additional year

What is the retention of improvements 24 months after a 2-week constraint-induced movement therapy (CIMT) intervention in stroke survivors? Follow-up 24 months after a single blind, cross over, randomised controlled trial of CIMT. This paper reports follow-up data for the intervention group that received CIMT without delay only. Seven US academic clinical sites. 106 out of 222 participants with mild to moderate post-stroke impairment who had experienced the stroke in the previous 3 to 9 months. CIMT was delivered for two weeks. During the two weeks, participants wore a padded protective mitt that covered their less impaired wrist and hand up to 6 h per day, 5 days per week. The mitt was to be worn for 90% of waking hours. During that time participants did adaptive task practice or repetitive practice of specific tasks, such as grooming or eating, continuously for 15–20 minutes. Contracts with participants and caregivers were used to promote adherence to mitt use. Primary outcomes were function of the paretic upper limb, measured with the Wolf Motor Function Test (WMFT) and the Motor Activity Log (MAL) measured at 12, 12.5, 16, 20, and 24 months. Health-related quality of life, measured with the Stroke Impact Scale (SIS), was a secondary outcome assessed at 12, 16, and 24 months. WMFT is a laboratory-based measure of upper limb motor function that consists of 15 timed movement tasks and two strength-based tasks. The MAL is a structured interview that assesses 30 activities of daily living on a 6-point scale when using the paretic arm. 34% of the participants who received CIMT immediately after allocation had dropped out at 24 months. From month 12 to month 24, the time taken to complete the WMFT did not decline significantly (mean difference 0.32 s longer, 95% CI –3.06 to 3.70). Over the same period, outcomes improved for weight lifted in the WMFT (1.39 kg, 95% CI 0.04 to 2.74) and for WMFT grip strength (4.39 kg, 95% CI 1.86 to 6.91). There were no significant differences in the amount of use in the MAL (0.17, 95% CI –0.04 to 0.38) and how well the limb was used in the MAL (0.14, 95% CI –0.06 to 0.34). Outcomes that had improved significantly 12 months after a 2-week CIMT program were maintained for an additional year.

Kinematic upper limb analysis in stroke patients undergoing constraint-induced movement therapy: 3-Month follow-up

Over sixteen million people suffer a stroke each year. Stroke is characterized by a one-sided paresis. Upper extremity and hand function are most limited. The current view on “neuro rehabilitation” advocates a constrained induced movement therapy (CIMT) setting. This case report seeks to illustrate the clinical reasoning and the feasibility of applying an alternative approach in patients who are not accepted or not suitable for the constrained induced movement therapy.A male patient, 68 years of age, developed impairments in his right arm and hand, such as loss of range of motion and strength besides spasticity after a stroke. This resulted in a loss of dexterity in his affected right side and in “disuse” of that arm and hand.A therapy was designed based upon the Proprioceptive Neuromuscular Facilitation-concept (PNF-concept) and consisting of PNF pattern exercises in a functional task setting with specified PNF-principles of facilitations and PNF-techniques for motor re-learning activities, over a period of six weeks. This resulted in clinical important improvements of wrist extension, grip strength, spasticity, dexterity and patient satisfaction with specific tasks.The provided comprehensive therapy mimics CIMT and robotics. The approach addresses possibly motor learning effects, cortical reorganization and structural impairments. Proprioceptive Neuromuscular Facilitation (PNF) - diagonal movement patterns have been described as: “having beneficial effects in cortical adaptations and cortical organization resulting in motor learning effects”. In cases where CIMT is difficult to apply, a specified PNF-based therapy has shown to be a feasible alternative.

Chronic pain: A non-use disease

One of the major problems in modern medicine is to find remedies for the group of people with chronic pain syndromes. Low back pain is one of the most frequent syndromes and perhaps the most invalidating of all of them. Chronic pain seems to develop through several pathways affecting the spinal cord and the brain: (1) neuro-anatomical reorganisation, (2) neuro-physiological changes, and (3) activation of glia cells (immune reaction in the central nervous system). Although all of these pathways seem to provide a (partial) plausible explanation for chronic pain, treatments influencing these pathways often fail to alleviate chronic pain patients. This could be because of the probability that chronic pain develops by all three mechanisms of disease. A treatment influencing just one of these mechanisms can only be partially successful. Other factors that seem to contribute to the development of chronic pain are psychosocial. Fear, attention and anxiety are part of the chronic pain syndrome being cause or consequence. The three pathways and the psycho-emotional factors constitute a psycho-neuro-immunological substrate for chronic pain syndromes; a substrate which resembles the substrate for phantom pain and functional invalidity after stroke. Both phantom pain and functional invalidity are considered non-use syndromes. The similarity of the substrate of both these two neurological disorders and chronic pain makes it reasonable to consider chronic pain a non-use disease (the hypothesis). To test this hypothesis, we developed a "paradoxal pain therapy". A therapy which combines the constraint induced movement therapy and strategies to dissociate pain from conditioning factors like fear, anxiety and attention. The aim of the therapy is to establish a behaviour perpendicular on the pathological pain-behaviour. Clinically, the treatment seems promising, although we just have preliminary results. Further clinical and laboratory studies are needed to measure eventual changes at neuro-anatomical and neuro-psychological level using modern neuro-imaging instruments (PET, SPECT, fMRI). Randomised clinical trials should be carried out to test our hypothesis for all-day use in clinical practice. The hypothesis: chronic pain is a non-use disease produced by psycho-emotional factors like fear, attention and anxiety. Optimal treatment should be based on physiological use, and dissociation of pain and the mentioned psycho-emotional factors. Paradoxal pain therapy could serve these treatment conditions.

Increased fMRI activation in the primary sensorimotor cortex (M1S1) after constraint induced movement therapy in congenital hemiparesis

Objectives: Constraint Induced Movement Therapy (CIMT) is an effective approach to improve the paretic hand function in children with congenital hemiparesis. The scope of our study was to assess the neurobiological basis for the functional improvement after CIMT by functional MRI (fMRI).

CIMT as a behavioral engine in research on physiological adjuvants to neurorehabilitation: The challenge of merging animal and human research

A physiological adjuvant to neuroplasticity cannot put new knowledge into the brain - it can only augment behavioral rehabilitation, which does replace knowledge in the brain lost due to injury. Clinical trials of adjuvant agents should therefore incorporate behavioral engines: behavioral therapies that have a potent effect and minimize error variance due to variability in subject attributes and the administration of the therapy. We consider in some detail the attributes of behavioral engines with a particular focus on constraint induced movement therapy. Human trials of physiological adjuvants to neuroplasticity are predicated on discoveries from animal research. Because human trials are expensive and carry risk of injury, it behooves us to lay a comprehensive foundation for these trials with animal studies (also incorporating behavioral engines) and to carefully mesh animal and clinical work. We review in detail our own and others' work involving human subjects with brain lesions and animal models of brain injury using donepezil, a central acetyl cholinesterase inhibitor, d-cycloserine, a partial agonist at the NMDA receptor glycine site, d-amphetamine, and methylphenidate in an effort to elucidate the strengths and weakness of animal and human neurorehabilitation science with respect to this mesh between animal and human subject research. We consider modifications in current approaches that might more efficiently advance neurorehabilitation science.

CI therapy distribution: Theory, evidence and practice

Traditional rehabilitation for hemiplegia is not necessarily based on a supported theoretical foundation and some evidence questiones the efficacy of current practice. The uncertainty relating to underlying theories is a serious issue, henceforth there has been a move to base treatment strategies on scientific foundations which incorporate knowledge of human learning mechanisms and accompanying neurobiological processes. In this paper we argue that constraint induced movement therapy is a potentially very effective intervention that benefits from a strong theoretical grounding. It is demonstrated that the treatment mechanisms are supported by established behavioural learning theory and evidence of brain plasticity. As empirical support for the therapy is gradually mounting, the integration into mainstream practice lends itself as a natural course. In this paper, a series of issues surrounding the distribution of CIT such as constraint use, dose response relationships and accessibility to a wider group of patients are discussed. Further research in these areas is considered important for CIT integration into mainstream practice.

Effects of constraint-induced movement therapy in adolescents with hemiplegic cerebral palsy: A day camp model

This study examined whether restraining the dominant hand during an intensive training period could provide a means by which to improve adolescents’ hemiplegic hand function. Nine adolescents with hemiplegic CP between the ages of 13 and 18 years were enrolled at a two-week day camp, of 7 hours/day. They were restricted in the use of their dominant hand in various daily and recreational activities by wearing a glove-like splint. The basis for intervention was built upon the adolescents’ own motivation, and the activities were chosen to be challenging and specifically to provide opportunities for repetition. The treatment approach used was an adapted model of Constraint Induced Movement Therapy. Assessments took place before and after intervention as well as at a 5-month follow-up. The results revealed that hand function did improve and was sustained at follow-up for dexterity, coordination and precision, and manipulative abilities. The performance of tasks that had been trained specifically showed major improvements.

CONSTRAINT INDUCED MOVEMENT THERAPY IN CONGENITAL HEMIPARESIS III: FMRI REVEALS INCREASED ACTIVATION IN PRIMARY SENSORIMOTOR CORTEX (M1S1)

Objectives: To assess the neurobiological basis for the functional improvement achieved by Constraint Induced Movement Therapy (CIMT) in congenital hemiparesis.

CONSTRAINT INDUCED MOVEMENT THERAPY FOR AN INDIVIDUAL EXHIBITING HEMIAKINESIA POST STROKE.

Background & Purpose: Patients with hemiakinesia exhibit the inability to carryout purposeful movements in the absence of paresis. They may not spontaneously use their upper extremity contralateral to the lesion. When asked to move they may have the ability to coordinate movements. During manual muscle testing they demonstrate good to normal strength. This has been a clinically challenging scenario and few interventions have been advocated to remediate hemiakinesia. The purpose of this case study was to examine the effect of Constraint Induced Movement Therapy (CIMT) on upper extremity (UE) performance. Case Description: The individual was a 39 year old right handed white female seen 11 months after a major left putamenal hemorrhage during her fifth month of pregnancy. She exhibited aphasia, anomia, pronounced hemiakinesia with right UE strength 4+ to 5, mild right shoulder subluxation, mild increased tone, normal propriocep-tion, stereognosis, impaired 2-point discrimination and minimal spontaneous use of her right UE. She initially scored 1.00 on the Amount of Use of the Motor Activity Log (MAL) indicating very rare use. The initial Actual Amount of Use Test (AAUT) was 0.53 in Amount and 1.12 in Quality. She was an independent ambulator at 1.16 meters per second (mps) self-selected speed and 1.69 mps fast walking. She did not exhibit any right arm swing. Prior to the stroke she was a dental hygienist, homemaker and active in her community. She lived at home with her husband, two children requiring help from caregivers. Her goals were to become more independent in cooking, child care and driving. She participated in CIMT for 6 hours/day for 10 days and was mitt compliant at least 90% of waking hours. Outcomes: Outcome measures were collected pre, post, 6 and 12 months. At post-test, amount and quality of arm use (MAL) increased almost to the pre-stroke levels (4.8 and 4.6, respectively). This was maintained at 3.98 and 4.05 at 12 months. The AAUT continued improving at 6 months, in both maximum amount 1.71 and maximum quality 3.19. Times on the Wolf Motor Function Test improved from 2.69 seconds to 1.7 post CIMT, approaching the less involved side (1.35), however, increased to 2.21 at 6 months and 5.63 at 12 months. Fugl Meyer improved across all testing from baseline 56 to 61 at 12 months. Box and Blocks Test initially increased from 31 to 37 post CIMT and maintained an average of 56% of the left UE extremity at 12 months. MOS-36 increased from 22 to 28 post and 29 at 12 months. Geriatric Depression Scale decreased from 7 to 4 after CIMT. The personal goals for childcare and resuming driving were attained. Discussion: Outcomes demonstrated the potential value and efficacy of CIMT as an intervention for the challenging problem of hemiakinesia. Measures of function and quality of life substantiate the participant's perception of improvement and gains. This case study illustrates a potential application of CIMT for hemiakinesia post-stroke.

CORTICAL REORGANIZATION AND MOTOR RECOVERY AFTER CONSTRAINT INDUCED MOVEMENT THERAPY IN ACUTE STROKE: A PRELIMINARY REPORT.

PURPOSE/HYPOTHESIS: Purpose of the study was threefold. First, to determine in a preliminary, small randomized parallel group study, whether Constraint Induced Movement Therapy (CIMT) in acute stroke was feasible, safe, and caused beneficial changes in motor function. Second, to determine the feasibility of using transcranial magnetic stimulation (TMS) to assess motor cortical reorganization in acute stroke. Third, to determine whether the cortical reorganization of movement control as measured with TMS correlates with improved motor function. Based on positive results from this study, a larger scale study is now in progress. NUMBER OF SUBJECTS: 8 subjects were enrolled and randomizied in this preliminary study within 14 days of their stroke. Enrollment was based on the following exclusion criteria: less than 10 degrees of movement, as defined by scoring >3 on the Arm Motor Function (AMF) of the National Institutes of Health Stroke Scale (NIHSS), aphasia, prior stroke, too good movement as defined by scoring NIHSS AMF=0, confusion, pacemaker, Spanish speaking only, medical complications. MATERIALS/METHODS: CIMT group was restrained by wearing a soft mitten on the uninvoled hand for a target of 90% of waking hours over 14 days. CIMT treatment was modeled from Dr. Edward Taub's laboratory at the University of Alabama at Birmingham. CIMT included shaping tasks, which enabled patients to achieve success with their involved hand in order to suppress patterns of learned-nonuse. The control group received “traditional” rehab with the use of both hands. Treatment sessions included active and/or active-assistive range of motion, bimanual and unilateral activities. “Traditional” rehab also included tone modification and functional activities of daily living; modified or compensatory methods. CIMT and control treatment frequency was approximately 3 hours/day, 6 days/week over a 14 day period. TMS was used to map the cortical reorganization of the motor cortex pre & post treatment and again at a 3 month follow-up. Performance measures included: Grooved Pegboard Test (GPT), Fugl-Meyer (FM), and Motor Activiy Log (MAL). Performance measures were also measured pre & post treatment, and again at a 3 month follow-up. RESULTS: Motor performance of the involved hand improved in most patients in both treatment groups. However, the most significant differences between the 2 patient groups, noted both at post treatment and again at the 3 month follow-up, was the cortical reorganization that occurred in the lesioned hemisphere, as measured by TMS. Performance measures were significantly improved in the involved hand, as measured by the GPT and the FM. CONCLUSIONS: Preliminary results suggest that there is a strong relationship between cortical output maps for movement as determined by TMS and motor dexterity in the corresponding hand. CIMT in the acute stroke patient is safe and induces more cortical reorganization and recovery as compared to traditional therapy. CLINICAL RELEVANCE: CIMT is a safe intervention and induces cortical plasticity in acute stroke patients.

‘Clinical experience of constraint induced movement therapy in adolescents with hemiplegic cerebral palsy‐a day camp model’

Developmental Medicine & Child NeurologyVolume 45, Issue 5 p. 357-359 Free Access ‘Clinical experience of constraint induced movement therapy in adolescents with hemiplegic cerebral palsy-a day camp model’ Ann-Christin Eliasson PhD OT, Corresponding Author Ann-Christin Eliasson PhD OT aDepartment of Woman and Child Health, Karolinska Institutet, Stockholm bDepartment of Child and Youth Rehabilitation, Stockholm Sweden * Correspondence to: Ann-Christin Eliasson Department of Woman and Child Health Astrid Lindgrens Children's Hospital 171 76 Stockholm SwedenSearch for more papers by this authorBeatrice Bonnier MSc OT, Beatrice Bonnier MSc OT bDepartment of Child and Youth Rehabilitation, Stockholm SwedenSearch for more papers by this author Ann-Christin Eliasson PhD OT, Corresponding Author Ann-Christin Eliasson PhD OT aDepartment of Woman and Child Health, Karolinska Institutet, Stockholm bDepartment of Child and Youth Rehabilitation, Stockholm Sweden * Correspondence to: Ann-Christin Eliasson Department of Woman and Child Health Astrid Lindgrens Children's Hospital 171 76 Stockholm SwedenSearch for more papers by this authorBeatrice Bonnier MSc OT, Beatrice Bonnier MSc OT bDepartment of Child and Youth Rehabilitation, Stockholm SwedenSearch for more papers by this author First published: 13 February 2007 https://doi.org/10.1111/j.1469-8749.2003.tb00409.xCitations: 51AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume45, Issue5May 2003Pages 357-359 ReferencesRelatedInformation

Management of upper limb dysfunction in children with cerebral palsy: a systematic review.

Effective use of the upper limb can impact on educational outcomes, participation in activities of daily living and vocational options for many children with cerebral palsy (CP). This article presents the results of a systematic review of the literature on the management of upper limb dysfunction in children with CP. The range of management options includes therapies such as physiotherapy, occupational therapy, neurodevelopmental therapy and conductive education; peripheral splinting and casting; focal or generalized pharmacotherapy; and surgery to improve upper limb function or correct deformity. A literature search identified 60 papers, of which four were randomized controlled trials and 44 were prospective studies with objective outcome measures. Principal studies undertaken for each type of treatment and the efficacy of the different types of treatment were critically evaluated. In addition, the current level of evidence for each study was evaluated according to Sackett's (1989) model and ICIDH-2 classification. A close examination of two relatively new treatments for upper limb spasticity, constraint induced movement therapy and botulinum toxin type A (BTX-A) was conducted with reference to more extensive data on the efficacy of BTX-A in the lower limb.

Effectiveness of Constraint induced movement therapy as compared to bimanual therapy in Upper motor function outcome in child with hemiplegic Cerebral palsy.

Objective:This study aims at determining the effectiveness of constraint induced movement therapy as compared to bimanual therapy for improving functional status in children with hemiplegic cerebral palsy.Methods:This study was a randomized control trial, children (n = 20) with spastic hemiplegic cerebral palsy was randomly allocated to CIMT (constraint induced movement therapy) and BMT (bimanual therapy) group. The children with spastic hemiplegia, age between 1.5 and 12 year and having 10 degrees of wrist extension and 10 degrees of finger extension were included in study. Treatment regime was two hours of daily training six days a week for two weeks. Constraint was applied to CIMT group for six hours. The outcome tool QUEST was used for baseline and post treatment assessment.Result:CIMT had superior outcome as compared to BMT in improving functional status (p=0.007). On QUEST tool grasp and dissociated movements results were significant (p=0.005) and (p=0.028) respectively. Weight bearing and protective extension resulted in no significant outcome (p=0.080) and (p=0.149) respectively. Dissociated movements and grasp are significantly improved but there is no difference for weight bearing and protective extension in CIMT treated group as compared to BMT treated group.Conclusion:CIMT approach is better in improving functional status of child with cerebral palsy as compared to BMT. Significant improvement in grasp and dissociated movement is noted in group of CIMT while there was no significant improvement in weight bearing and protective extension in CIMT group when compared to BMT. CIMT is considered the appropriate treatment approach for unilateral conditions while BMT for bilateral conditions.