Pediatric Motor Activity Research Articles

The effect of constraint-induced movement therapy for children with hemiplegic cerebral palsy in Vietnam

Purpose Pediatric constraint-induced movement therapy (CIMT) is an evidence-based treatment that has a long history of demonstrating efficacy for children with hemiparesis. The purpose of this study is to determine the effectiveness of a culturally responsive CIMT program for children with hemiplegic cerebral palsy (CP) developed for the Vietnam healthcare system. Methods Thirty children with hemiplegic CP (mean age = 2.88 years, age range: 1 to 8 yrs, 60% male) were recruited to a CIMT program (7.5 h/week, 4 weeks) developed for the cultural context of Vietnam. Motor abilities of the affected arm and participation in daily activities were evaluated at 3 time points (one-week prior to CIMT (baseline), one-week before (pre) and after (post) CIMT) using the Quality of Upper Extremity Skill Test (QUEST) and Pediatric Motor Activity Log-Revised (PMAL-R). Individual goals were measured using the Goal Attainment Scale (GAS). Results There were significant increases in the “How often scale” and “How Well” scales of the PMAL-R (0.75 and 0.75, p < 0.00)). Score of Grasp and Dissociated Movement items on the QUEST increased significantly (6.47 and 7.63, p < 0.001). Group GAS T-Scores were 52.19 indicating that children met individual goals. Conclusions A model of CIMT was successfully developed and delivered within the Vietnamese healthcare system. Future studies should explore the optimal model for CIMT in various regions of world where the delivery of rehabilitation services may vary.

Identifying the most representative actigraphy variables reflecting standardized hand function assessments for remote monitoring in children with unilateral cerebral palsy

BackgroundAccurate assessment of physical activity and motor function in children with cerebral palsy is crucial for determining the effectiveness of interventions. This study aimed to investigate the correlation between real-world activity monitoring outcomes and in-laboratory standardized hand function assessments in children with unilateral cerebral palsy.MethodsActigraphy data were collected over 3 days from children aged 4–12 years with unilateral cerebral palsy before in-laboratory assessments. To tackle the high dimensionality and collinearity of actigraphy variables, we first applied hierarchical clustering using the Pearson correlation coefficient as the distance metric and then performed a principal component analysis (PCA) to reduce the dimensionality of our data.ResultsBoth hierarchical clustering and PCAs revealed a consistent pattern in which magnitude ratio variables (ln[affected side magnitude/less-affected side magnitude]) were more strongly associated with standardized assessments of hand function than with activity time and distance domain variables. Hierarchical clustering analysis identified two distinct clusters of actigraphy variables, with the second cluster primarily consisting of magnitude ratio variables that exhibited the strongest correlation with Melbourne Assessment 2, Pediatric Motor Activity Log, Assisting Hand Assessment, and Manual Ability Classification System level. Principal component 2, primarily representing the magnitude ratio domain, was positively associated with a meaningful portion of subcategories of standardized measures, whereas principal component 1, representing the activity time and distance component, showed limited associations.ConclusionsThe magnitude ratio of actigraphy can provide additional objective information that complements in-laboratory hand function assessment outcomes in future studies of children with unilateral cerebral palsy.Trial registration in ClinicalTrials.govNCT04904796 (registered prospectively; date of registration: 23/05/2021).

Investigation of Motor Activity, Movement Kinematics and Forward-Backwards Gait in Children with Cerebral Palsy.

Our aim in this study was to examine relationships between the motor activity ability, sensor-based kinematics and forward-backwards gait characteristics of children with cerebral palsy (CP). In this prospective cross-sectional study we studied 40 children with CP. We used the Pediatric Motor Activity Log Revised (PMAL-R) to assess motor activity, evaluated motion kinematics (acceleration and angular velocity) with a sensor-based application, applied the Edinburgh Visual Gait Score (EVGS) and the Timed Up and Go Test (TUG) to observe gait performance, and used the Three Meter Backward Walk Test (3MBWT) to assess backward gait. We found moderately positive significant correlations (r1 = 0.416, r2 = 0.418, p < 0.05) between the chilidren's minimum angular velocity on PMAL-R motor activity frequency (how often) and quality (how well) scores, respectively. We also found moderately negative significant correlations (r1 = -0.529, r2 = -0.521, p < 0.05) between PMAL-R frequency (how often) and quality (how well) scores with TUG, respectively. There were moderately high positive correlations (r1 = 0.415, r2 = 0.726, p < 0.05) between EVGS scores and 3MBWT and TUG scores, respectively. We concluded that angular velocity ability was moderately related to children's motor activity and showed that physical performance tests (TUG and 3MBWT) could monitor gait function and upper extremity motor activity level, including both forward and backward walking tasks, in children with CP.

Design and Use of a 3D-Printed Dynamic Upper Extremity Orthosis for Children With Cerebral Palsy and Severe Upper Extremity Involvement: A Pilot Study.

Children with cerebral palsy (CP) and severe hand impairment have limited options for upper extremity (UE) orthoses. To (1) design and fabricate a customized low-cost, functional, three-dimensional (3D) printed dynamic upper extremity orthosis (DUEO) and (2) examine, using a comprehensive evaluation, the effect of the orthosis on the UE function of children with unilateral UE CP, Manual Ability Classification System (MACS) Levels III to V. Pilot study. Assessments were performed pretreatment and immediately posttreatment. Hospital-based outpatient occupational therapy department. Five patients, ages 13 to 17 yr, with CP and unilateral UE involvement MACS Levels III to V. Custom forearm thumb opponens orthosis and the DUEO were designed and fabricated by a multidisciplinary team for use during eight 1-hr occupational therapy sessions targeting bimanual UE training. Pretreatment and posttreatment assessments included the Assisting Hand Assessment (AHA), Melbourne Assessment 2 (MA-2), Pediatric Motor Activity Log-Revised (PMAL-R), and the Pediatric Quality of Life Inventory: CP Module (PedsQL:CP). All participants had higher posttreatment scores on at least one measure. Four had minimal clinically important differences (MCID) on the AHA. Three met MCID criteria on MA-2 subtests (one negative change). Four demonstrated improvement on the PMAL-R (one participant achieved an MCID score), and three reported improvements in more than one PedsQL:CP domain. This novel 3D-printed device, in combination with occupational therapy, shows promising evidence that children who score in lower MACS levels can show gains in UE function. What This Article Adds: This study demonstrates that a customized, 3D-printed dynamic orthosis, in combination with occupational therapy intervention, can facilitate UE function in children with severe hand impairment.

Exploration of the relationship between functional motor and communication performance levels and amount of use of the more affected upper extremity based on the caregivers’ perceptions in children with hemiplegic cerebral palsy: A cross-sectional study

ObjectiveTo investigate relationships between amount of use of the more affected upper extremity and functional motor and communication performance classification systems. Material and methodsThe study comprised 95 children with congenital hemiplegic cerebral palsy (CP) aged 6–15 years (52 males, 43 females; mean age 9.53, SD 3.1) and their parents/caregivers. The amount of use of the more affected upper extremity was assessed using Pediatric Motor Activity Log-Revised-How Often subscale (PMAL-R HO). Functional levels of the enrolled children were defined by the parents/caregivers using Manual Ability Classification System (MACS), Gross Motor Function Classification System-Expanded and Revised (GMFCS-E&R), and Communication Function Classification System (CFCS). ResultsA strong and negative correlation was found between PMAL-R HO subscale score and MACS (r=−0.819), suggesting that children with lower MACS levels are more likely to use their more affected upper extremity spontaneously. Additionally, negative and moderate associations between PMAL-R HO subscale score and GMFCS and CFCS were revealed (r1=−0.549 and r2=−0.567). ConclusionThe amount of use of the more affected upper extremity is more sensitive to MACS than GMFCS-E&R and CFCS. Children with a given MACS level had a wide range of PMAL-R HO subscale score. In addition to MACS, a score on the PMAL-R HO subscale related to the more affected upper extremity should be included as an inclusion criterion in clinical trials to avoid misleading effects of intervention approaches aimed at improving the amount of use of the more affected upper extremity in children with congenital hemiplegic CP.

Effects of Intensive Versus Distributed Constraint-Induced Movement Therapy for Children With Unilateral Cerebral Palsy: A Quasi-Randomized Trial

Background Previous studies have compared the effectiveness of constraint-induced movement therapy (CIMT) by different training doses. However, whether the dosing schedule, that is, intensive or distributed, influences the effectiveness of CIMT in children with unilateral cerebral palsy (CP) is unknown. Objective To investigate the effectiveness of intensive and distributed CIMT for children with unilateral CP. Methods Fifty children with unilateral CP were assigned to intensive or distributed CIMT group with a total of 36 training hours. The intensive CIMT was delivered within 1 week, and the distributed CIMT was delivered twice a week for 8 weeks. The outcomes were the Melbourne Assessment 2, Box and Block Test, Pediatric Motor Activity Log-Revised (PMAL-R), Bruininks–Oseretsky test of motor proficiency 2, ABILHAND-Kids and Parenting Stress Index—Short Form. The intensive group was assessed at the initiation of treatment (week 0), at the end of 1 week treatment (week 1), and 8 weeks after the initiation of treatment (week 8). The distributed group was assessed at week 0 and week 8. Results The within-group analyses demonstrated significant differences on all motor outcomes. There were no significant between-group differences at post-treatment, while the intensive CIMT demonstrated larger improvements than the distributed CIMT did on quality of use of the more-affected hand, as rated by parents on the PMAL-R at week 8. Conclusions The 2 dosing schedules of CIMT had similar effectiveness for children with unilateral CP. The intensive CIMT yielded additional improvement on parent rated motor quality of the more-affected hand at 8 weeks after the initiation of treatment. Trial registration: ClinicalTrials.gov (ID: NCT03128385)

Comparative effects of kinect-based versus therapist-based constraint-induced movement therapy on motor control and daily motor function in children with unilateral cerebral palsy: a randomized control trial

BackgroundConstraint-induced movement therapy (CIMT) is a prominent neurorehabilitation approach for improving affected upper extremity motor function in children with unilateral cerebral palsy (UCP). However, the restraint of the less-affected upper extremity and intensive training protocol during CIMT may decrease children’s motivation and increase the therapist’s workload and family’s burden. A kinect-based CIMT program, aiming to mitigate the concerns of CIMT, has been developed. The preliminary results demonstrated that this program was child-friendly and feasible for improving upper extremity motor function. However, whether the kinect-based CIMT can achieve better or at least comparable effects to that of traditional CIMT (i.e., therapist-based CIMT) should be further investigated. Therefore, this study aimed to compare the effects of kinect-based CIMT with that of therapist-based CIMT on upper extremity and trunk motor control and on daily motor function in children with UCP.MethodsTwenty-nine children with UCP were recruited and randomly allocated to kinect-based CIMT (n = 14) or therapist-based CIMT (n = 15). The intervention dosage was 2.25 h a day, 2 days a week for 8 weeks. Outcome measures, namely upper extremity and trunk motor control and daily motor function, were evaluated before and after 36-h interventions. Upper extremity and trunk motor control were assessed with unimanual reach-to-grasp kinematics, and daily motor function was evaluated with the Revised Pediatric Motor Activity Log. Between-group comparisons of effectiveness on all outcome measures were analyzed by analysis of covariance (α = 0.05).ResultsThe two groups demonstrated similar improvements in upper extremity motor control and daily motor function. In addition, the kinect-based CIMT group demonstrated greater improvements in trunk motor control than the therapist-based CIMT group did (F(1,28) > 4.862, p < 0.036).ConclusionKinect-based CIMT has effects comparable to that of therapist-based CIMT on UE motor control and daily motor function. Moreover, kinect-based CIMT helps decrease trunk compensation during reaching in children with UCP. Therefore, kinect-based CIMT can be used as an alternative approach to therapist-based CIMT.Trial registration: ClinicalTrials.gov Identifier: NCT02808195. Registered on 2016/06/21, https://clinicaltrials.gov/ct2/show/NCT02808195.

The Effect of Occupation-Based Modified Constraint-Induced Movement Therapy on the Participation of Children with Cerebral Palsy: A Single-Blind Randomized Controlled Trial.

This study investigates the impact of modified constraint-induced movement therapy (m-CIMT), accompanied by occupation-based and activity analysis, on the participation of children with hemiplegia. Twenty-three participants were randomly assigned to the intervention and control groups. The intervention group received occupation-based m-CIMT (m-CIMT along with occupation-based and activity analysis), while the control group received m-CIMT without occupation-based and activity analysis. The intervention was conducted one hour per day, three days a week, for four weeks. The primary outcomes revealed no significant differences between groups in promoting the participation of children with hemiplegia in the activities of daily living (ADL). However, scores were higher in the intervention group with a medium to large effect size (Canadian occupational performance measure: F(1,19)=2.14, P=0.160, η2P=0.101, Canadian occupational performance measure-satisfaction: F(1,19)=1.53, P=0.231, η2P=0.075, Goal attainment scaling: F(1,19)=5.55, P=0.029, η2P=0.226). This effect remained during the follow-up period. The secondary outcomes indicated no significant differences between groups in improving the manual ability of the children. However, scores were higher in the intervention group with a medium to large effect size (ABILHAND-Kids: F(1,19)=0.64, P=0.434, η2P=0.033, pediatric motor activity log- how long: F(1,19)=3.53, P=0.076, η2P=0.157, pediatric motor activity log- how well: F(1,19)=2.59, P=0.124, η2P=0.120). This effect was sustainable during the follow-up period. m-CIMT accompanied by occupation-based and activity analysis and the client-centered paradigm substantially enhances the manual ability of children with hemiplegia and their participation in the ADL.

Effects of Expanded Constraint-Induced Movement Therapy on Hand Function in Children with Cerebral Palsy: A Randomized Controlled Trial

Background: Hemiplegic cerebral palsy children can attend schools regularly, but due to impairment of upper limb function, participation is restricted in leisure and educational tasks and it affects their social and functional activities. Constraint-induced movement therapy is specifically used for the upper extremity and can enhance cerebral palsy children’s hand function. Objective: To evaluate the effectiveness of expanded constraint-induced movement therapy on hand function in children with cerebral palsy. Methods: A single-blinded randomized controlled trial was conducted at the department of Physical Therapy, Children’s Hospital, Lahore, Pakistan from December 2021 to April 2022 using non-probability convenient sampling. Children with hemiplegic cerebral palsy aged between 5 and 12 years were randomly allocated into two groups (22 patients per group), the experimental group treated with expanded constraint-induced movement therapy and routine physical therapy and the conventional group treated with routine physical therapy only. The pediatric motor activity log scale and Wolf motor function test were the outcome measuring scales. The trial was approved by the ethical committee of the hospital and registered prospectively in the clinical trial registry of the US (ClinicalTrials.gov trial ID 57520). Results: As compared to the conventional group, the score of the pediatric motor activity log scale improved significantly (p-value ≤0.001) in the experimental group. Participants showed significant differences for both domains of the wolf motor function test in the experimental group as compared to other groups and they showed significant improvement in hand function (p≤0.001) within the groups. Conclusion: Expanded constraint-induced movement therapy along with routine physical therapy is found to be more effective in improving the function of the pelagic hand in children with hemiplegic cerebral palsy.

“How Well” and “How Often” questions for birth brachial plexus injury: a validity and reliability of the pediatric upper extremity motor activity log-revised

Purpose The pediatric upper extremity motor activity log-revised (PMAL-R) is a structured interview that measures use of the affected arm in daily life in children with unilateral pathologies like hemiparetic cerebral palsy (CP) or birth brachial plexus injury (BBPI). This study investigated validity and test–retest reliability of the PMAL-R in children with BBPI. Materials and methods The PMAL-R was administered to parents of 132 children with BBPI between 5 and 9 years for validity, also 98 parents were re-interviewed after 3 weeks to establish test–retest reliability. Its concurrent validity was examined by correlating scores on the PMAL-R How Well (HW) and How Often (HO) scales with Brachial Plexus Outcome Measure (BPOM) and Pediatric Outcomes Data Collection Instrument (PODCI) scores. Results PMAL-R scores were strongly correlated with BPOM scores (HW, r = 0.943, p < 0.001; HO, r = 0.897, p < 0.001), also strongly correlated with PODCI (HW, r = 0.799, p < 0.001; HO, r = 0.797, p < 0.001). PMAL-R test–retest reliability (intraclass correlation; HO = 0.997, HW = 0.998) and internal consistency (Cronbach’s a; HO = 0.99, HW = 0.99) were high. Conclusions The PMAL-R has good reliability and validity for measuring everyday use of the affected arm with “how often” and “how well” questions in children with BBPI. Implications for rehabilitation The pediatric upper extremity motor activity log-revised (PMAL-R) is the first tool to assess both “how often” and “how well” the affected arm is used in unimanual activities in children with BBPI. PMAL-R is a real-world measure providing valuable information about “how often” and “how well” the affected arm is used to guide treatment. PMAL-R is valid in both concurrent and discriminative validity in children with BBPI. PMAL-R is reliable in children with BBPI.

398 The Feasibility of Designing and Using a 3-D Printed Dynamic Upper Extremity Orthosis (DUEO) with Children with Cerebral Palsy and Severe Upper Extremity Involvement

OBJECTIVES/GOALS: To evaluate whether a low cost, functional dynamic 3-D printed upper extremity (UE) orthosis could be designed, fabricated and used by children with cerebral palsy (CP) with severe unilateral UE involvement and the ability of common standardized instruments to assess its effectiveness. METHODS/STUDY POPULATION: Five patients, ages 13-17 years, with CP and unilateral UE involvement, MACS levels III-IV, were enrolled. Custom forearm thumb opponens orthosis and dynamic upper extremity orthosis (DUEO) were designed and fabricated by a multidisciplinary team for use during 8 one-hour occupational therapy sessions targeting bimanual UE training. Pre- and post-assessments included Assisting Hand Assessment(AHA), Melbourne-2(MA-2), Pediatric Motor Activity Log-Revised(PMAL-R), and PedsQL Measurement Model for the Pediatric Quality of Life Inventory: CP Module(Peds-QL). RESULTS/ANTICIPATED RESULTS: The 3D printed orthotic device is custom fit to the patient based on scans of their arm and is designed with a tensioning system that allows for functional usage of the arm. It incorporates a rigid polymer to provide support and flexible material for comfort where appropriate. Overall, higher post-treatment scores were found for the majority of participants using the custom orthotic. Four made minimal clinically important differences (MCID) in the AHA. Three met MCID scores in subtests of MA-2 (two positive and one negative). Patient-reported outcome improvements were found for PMAL-R for four, but only one met MCID and at least three reported improvements in more than one domain of PedsQL. DISCUSSION/SIGNIFICANCE: Children with CP may often present with UE impairment, yet current therapeutic orthoses only target the progression of contractures and are still limited by cost and discomfort. Our team designed and fabricated a functional, low cost, 3D printed orthosis that showed significant gains in UE function.

Measurement properties of the box and block test in children with unilateral cerebral palsy

This study aimed to examine the reliabilities (test–retest reliability and measurement error), construct validity, and the interpretability (minimal clinically important difference) of the Box and Block Test (BBT) to interpret test scores precisely for children with UCP. A total of 100 children with UCP were recruited and 50 children from the whole sample assessed the BBT twice within 2-week interval. The BBT, the Melbourne Assessment 2, the Bruininks–Oseretsky Test of Motor Proficiency, 2nd Edition, and the Pediatric Motor Activity Log Revised were measured before and immediately after a 36-h intensive neurorehabilitation intervention. Measurement properties of the BBT were performed according to the COnsensus-based Standards for the selection of health Measurement INstruments checklist. The test–retest reliability of the BBT was high (intraclass correlation coefficient = 0.98). The measurement error estimated by the MDC95 value was 5.95. Construct validity was considered good that 4 of 4 (100%) hypotheses were confirmed. The interpretability estimated by the MCID ranged from 5.29 to 6.46. The BBT is a reliable and valid tool for children with UCP. For research and clinical applications, an improvement of seven blocks on the BBT is recommended as an indicator of statistically significant and clinically important change.

Validity and reliability of the Turkish version of the pediatric motor activity log-revised (PMAL-R) for 2–17 year old children with hemiparetic cerebral palsy

Purpose The Pediatric Upper-extremity Motor Activity Log-Revised (PMAL-R) is a structured interview that measures use of the more-affected arm in daily life in children with cerebral palsy (CP). This study investigated the concurrent validity and test-retest reliability of a Turkish version of the PMAL-R. Materials and methods The PMAL-R was translated and cross-culturally adapted to Turkish and administered to parents of eighty children with hemiplegic CP between 2-17 years. Its concurrent validity was examined by correlating scores on the PMAL-R How Well and How Often scales with ABILHAND-Kids scores. Fifty parents were re-interviewed after three weeks to establish test-retest reliability. Results PMAL-R scores were strongly correlated with ABILHAND-Kids scores (How Well scale, r = 0.78, p < 0.001; How Often scale, r = 0.59, p < 0.001). PMAL-R test-retest reliability (Intraclass correlation; How Often = 0.98, How Well = 0.99) and internal consistency (Cronbach's α; How Often = 0.96, How Well = 0.97) were high. Conclusions This translation of the PMAL-R has good reliability and validity for measuring everyday use of the more-affected arm in Turkish children with hemiparesis due to CP between 2–17 years. Implications for rehabilitation An instrument that evaluates real-world arm use in Turkish children with CP. Reliability and concurrent validity of the Turkish PMAL-R is established in 2–17-year old with upper-extremity hemiparesis. Systematic replication of the clinimetric properties of the English PMAL-R is demonstrated in a wider age range than previously, 2–17 years vs. 2–8 years. Reliability and concurrent validity of the PMAL-R is shown in both children with right and left hemiparesis.

Intervention bimanual stimulates the abilities in infants with asymmetry

Abstract Introduction: The cerebral palsy and brachial plexus injury may cause asymmetry in the use of the upper limbs (UL). This condition requires early treatment to reduce the impact of the child's life; therefore, several proposed interventions aim to increase their functional independence. The Constraint-Induced Movement Therapy (CIMT) and Hand-Arm Bimanual Intensive Therapy (HABIT) have been widely considered effective interventions to improve hand function. Objective: Investigate the effects of an intervention protocol based on the CIMT and HABIT theoretical foundations in the stimulation of manual function in infants with the UL asymmetry. Methods: Five infants (6-24 months) participated in the study. To evaluate the motor function of infants we used Pediatric Motor Activity Log (PMAL-R) and Manual Function Evaluation (AMIGO), and to assess the caregiver's perception of the participation of the infant in daily tasks, we used the Pediatric Disability Assessment Inventory (PEDI). All evaluations occurred before, immediately after the intervention, and after four months for follow-up recording, and were analyzed descriptively by Jacobson- Truax method. Results: The results between evaluation and reevaluation demonstrated evolution in all aspects studied. In the PEDI self-care session, an average of 38.6 (±8.4) - 44.2 (±7.4); PEDI Mobility: 28.8 (±20.3) - 36.28 (±21.7); PEDI Social Function: 40.1 (±10.2) - 42.3 (±8.9). The PMAL-R quantity and quality results evidence a highly positive clinical significance in all infants. Conclusion: The application of the modified restriction intervention protocol resulted in reliable and clinically significant changes in all cases.

Functional outcomes of botulinum neurotoxin-A injection followed by reciprocal electrical stimulation in children with cerebral palsy: A randomized controlled trial.

The integration of therapeutic approaches is increasingly recommended for children with cerebral palsy, to enhance outcomes. Nevertheless, clinicians still opt for separate or combined therapies based on little credible knowledge. This study endeavored to evaluate the effect of botulinum neurotoxin-A (BoNT-A) injection and reciprocal neuromuscular electrical stimulation (rNMES) and their combination on the upper extremity function in children with spastic hemiplegia. Sixty-four children with spastic hemiplegia (aged 6- 10 years) were randomly assigned to four treatment-based groups [group I (BoNT-A), group II (rNMES), group III (combined BoNT-A and rNMES), and group IV (Control)]. All children received a physical rehabilitation program, thrice/week over three months. Unilateral upper-limb function, bimanual hand function, and real-time arm-hand function were assessed using Melbourne Assessment (MA), Assisting Hand Assessment (AHA), and Pediatric Motor Activity Log (PMAL) scales respectively pre-treatment, post-treatment, and at 6 months follow-up. Post-treatment, group III achieved greater improvement in MA, AHA, and PMAL compared to other groups (all P < 0.05), and the difference remained in favor of group III at the follow-up (all P < 0.05). This study suggests that BoNT-A and rNMES combined are more effective than either of them alone to enhance upper-extremity function in children with spastic hemiplegia.

Constraint-induced movement therapy for children with neonatal brachial plexus palsy: a randomized crossover trial.

To determine if constraint-induced movement therapy (CIMT) is more effective than standard care in improving upper-limb activity outcomes in children with neonatal brachial plexus palsy (NBPP). Twenty-one children with NBPP (mean age 25mo, SD=10.3, range=17-48mo; 11 males, 10 females) were enrolled in a crossover trial and randomly allocated to first receive CIMT or standard care, each for 8 weeks. The intervention arm consisted of 3 weeks of casting the unaffected limb followed by 5 weeks of transference activities. The Assisting Hand Assessment (AHA) was used to measure bimanual activity performance at baseline, 8 weeks, and 16 weeks, scored by blinded raters. The Pediatric Motor Activity Log-Revised (PMAL-R) was used as a caregiver-reported secondary outcome measure. After concealed random allocation (n=21), there were no significant differences on demographics or baseline measures. CIMT was superior compared to control in terms of bimanual activity performance with a mean difference in AHA change score of 4.8 (SD=10.5, p=0.04, Cohen's δ=0.46). There were no significant differences between treatment conditions on the PMAL-R. CIMT is favored over standard care for bimanual activity performance. Future research should investigate a longer follow-up period, additional comparator interventions, and analyse differences by participant characteristics. Gains in bimanual activity performance were greater after constraint-induced movement therapy (CIMT) compared to no CIMT. Frequency and quality of movement were not significantly different between treatment groups.

Induced Contention Therapy and functional bandage in children with cerebral palsy: Case report

Background: The decrease in the manual activity of hemiparetic children, affects their functionality and independence. Among the therapies used to improve manual function, there is Induced Contention Therapy (ICT) and functional bandaging (FB). Such approaches aim to improve the use and decrease the disuse learned from the upper limb in subjects with hemiparesis. Objective: Identify the effect of ICT, associated with the application of functional bandaging on the affected upper limb, in the function of the upper limb and on the handgrip of a child with spastic hemiplegic cerebral palsy. Methods: A 5-year-old child received ICT for three hours daily for three consecutive weeks associated with FB in the right upper limb. The use of the upper limb was evaluated using the Pediatric Upper Extremity Motor Activity Log (PMAL) scale, the acquisition of new motor standards using the Inventory of New Motor Activities and Program (INMAP) scale, the motor skill by the Pediatric Arm Functional Test (PAFT) and the handgrip strength by the dynamometer. Results: There was an improvement in the quantity and quality of use of the paretic upper limb after the application of ICT, which remained after one month of therapy. In addition, it was observed the acquisition of new motor skills and improvement in handgrip strength. Conclusion: This study had a potential positive effect on handgrip strength, functionality and quality of use of the paretic upper limb of a child with spastic CP after the application of ICT associated with functional bandaging.

Effects of Modified Constraint-Induced Movement Therapy in Real-World Arm Use in Young Children with Unilateral Cerebral Palsy: A Single-Blind Randomized Trial.

To determine whether modified constraint-induced movement therapy (mCIMT) with continuous restraint is feasible and effective in improving the use of the paretic arm in the real world among infants and toddlers with unilateral cerebral palsy (CP). Single-blind randomized controlled trial. Tertiary hospital. Children aged 7 to 36 months with unilateral CP (N = 24; 16 boys, 8 girls). The experimental group received 2-hour clinic-based mCIMT sessions (5 days per week for 3 weeks), and a continuous restraint was applied. Standardized assessments were conducted. Peabody Developmental Motor Scales-2 (PDMS-2), Gross Motor Function Measure-66, Pediatric Motor Activity Log (PMAL), and Pediatric Evaluation of Disability Inventory were measured pre- and postintervention. Children who agreed to participate in the accelerometer study additionally wore accelerometers on both their wrists for 3 days before and after the intervention. The mCIMT group exhibited greater improvement in PMAL-how often (p = 0.048; ηp2 = 0.173), PMAL-how well (p = 0.008; ηp2 = 0.289), and PDMS-2 visual motor integration (p = 0.014; ηp2 = 0.256) posttreatment than the control group. The percentage of time in moderate-to-vigorous physical activity (z = -2.24; p = 0.03) and vector magnitude average counts (z = -2.52; p = 0.01) significantly increased in children in who wore accelerometers (N = 8) after the 3-week mCIMT protocol. mCIMT with continuous restraint applied to infants and toddlers with unilateral CP appeared to have a positive effect on paretic hand use in the real world. NCT03418519.

Does well-functioning hand constraint induce stress in forced-use therapy for children with unilateral cerebral palsy?

This study investigated the stress induced by well-functioning hand constraint in forced-use therapy (FUT) for children with unilateral spastic cerebral palsy (CP).Seventeen children with unilateral spastic CP (mean age 5.8 years) received FUT: 4-week unaffected upper limb immobilization with a short-arm Scotchcast and were encouraged to incorporate it to their daily routines and plays. They were evaluated at pretreatment, immediate post-treatment, and 6 months post-treatment. The Korea-Child Behavior Checklist (K-CBCL) was used to assess the stress degree; box and block test (BBT), Erhardt Developmental Prehension Assessment (EDPA), Quality of Upper Extremity Skill Test (QUEST), and Pediatric Motor Activity Log (PMAL), upper limb function; and Pediatric Evaluation of Disability Inventory (PEDI), daily living activities.In the preschoolers, most scores of K-CBCL tended to increase after FUT; however, there was no significant change in all scale findings after FUT. In the school-aged children, most scores of K-CBCL tended to decrease after FUT; however, there was no significant change in all scale findings after FUT. The findings of the BBT, QUEST, PMAL how often and well subscales significantly improved post-treatment (P < .05).The 4-week FUT with well-functioning hand constraint significantly improved the UL function and did not induce emotional and behavioral problems in children with unilateral spastic CP.

BRAZILIAN VERSION OF THE SHRINERS HOSPITAL UPPER EXTREMITY EVALUATION (SHUEE): TRANSLATION, CULTURAL ADAPTATION, AND EVALUATION OF PSYCHOMETRIC PROPERTIES.

ABSTRACTObjective: To validate the upper limb assessments tool, Shriners Hospital Upper Extremity Evaluation (SHUEE), for individuals with hemiplegic cerebral palsy in the Brazilian population.Methods: Validation study to translate and culturally adapt the Manual and the instrument. The psychometric properties evaluated were reliability and convergent validity. Reliability was determined by internal consistency (Cronbach’s α coefficient), ceiling and floor effect, sensitivity to changes, and intra- and interobserver agreement. Convergent validity was performed using the Pediatric Motor Activity Log, the self-care scale of the Pediatric Evaluation of Disability Inventory, and the Manual Ability Classification System.Results: We evaluated 21 individuals with hemiplegic cerebral palsy, with a mean age of 8.7±4.0 years. After the instrument was translated, there was no need for cultural adaptation. The total Cronbach’s α coefficient was 0.887 (95% confidence interval [95%CI] 0.745-0.970). We calculated sensitivity to changes in five subjects who underwent treatment with Botulinum Toxin Type A and physical therapy, with a significant difference between pre- and post-treatment evaluations in the Spontaneous Functional Analysis and Dynamic Positional Analysis. Convergent validity showed a significant correlation of the Spontaneous Functional Analysis and Dynamic Positional Analysis with the scales evaluated. All items of SHUEE presented high intra- and interobserver agreement.Conclusions: The results revealed that the Brazilian version of the SHUEE demonstrated good reliability and convergent validity, suggesting that it is an adequate and reliable tool for individuals with hemiplegic cerebral palsy in the Brazilian population.