Constraint-induced movement therapy improves upper limb activity and participation in hemiplegic cerebral palsy: a systematic review

Objective: To determine the feasibility and short-term efficacy of caregiver-directed constraint-induced movement therapy to improve upper limb function in young children with hemiplegic cerebral palsy. Design: Randomized controlled trial with masked assessment. Setting: Community paediatric therapy services. Subjects: Pre-school children with hemiplegic cerebral palsy. Interventions: Caregiver-directed constraint-induced movement therapy administered using either 24-hour short-arm restraint device (prolonged) or intermittent holding restraint during therapy (manual). Main measures: Primary measures include Assisting Hand Assessment (AHA) at 10 weeks. Secondary measures include adverse events, Quality of Upper Extremity Skills Test and Pediatric Quality of Life Inventory. Feasibility measures include recruitment, retention, data completeness and adherence. Results: About 62/81 (72%) of eligible patients in 16 centres were randomized (prolonged restraint n = 30; manual restraint n = 32) with 97% retention at 10 weeks. The mean change at 10 weeks on the AHA logit-based 0–100 unit was 9.0 (95% confidence interval (CI): 5.7, 12.4; P < 0.001) for prolonged restraint and 5.3 (95% CI: 1.3, 9.4; P = 0.01) for manual restraint with a mean group difference of 3.7 (95% CI: −1.5, 8.8; P = 0.156) (AHA smallest detectable difference = 5 units). No serious related adverse events were reported. There were no differences in secondary outcomes. More daily therapy was delivered with prolonged restraint (60 vs 30 minutes; P < 0.001). AHA data were complete at baseline and 10 weeks. Conclusion: Caregiver-directed constraint-induced movement therapy is feasible and associated with improvement in upper limb function at 10 weeks. More therapy was delivered with prolonged than with manual restraint, warranting further testing of this intervention in a longer term trial.

Download Full-text

Efficacy of modified constraint induced movement therapy in improving upper limb function in children with hemiplegic cerebral palsy: A randomized controlled trial

Brain and Development ◽

10.1016/j.braindev.2012.11.001 ◽

2013 ◽

Vol 35 (9) ◽

pp. 870-876 ◽

Cited By ~ 27

Author(s):

Anita Choudhary ◽

Sheffali Gulati ◽

Madhulika Kabra ◽

Upinder Pal Singh ◽

Naveen Sankhyan ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Cerebral Palsy ◽

Upper Limb ◽

Controlled Trial ◽

Movement Therapy ◽

Limb Function ◽

Randomized Controlled ◽

Upper Limb Function ◽

Constraint Induced Movement Therapy ◽

Hemiplegic Cerebral Palsy

Download Full-text

Constraint-induced movement therapy of upper limb of children with cerebral palsy in clinical practice: systematic review of the literature

Fisioterapia e Pesquisa ◽

10.1590/1809-2950/17425124032017 ◽

2017 ◽

Vol 24 (3) ◽

pp. 334-346 ◽

Cited By ~ 1

Author(s):

Paulo Roberto Fonseca Junior ◽

Eduardo Filoni ◽

Chrystianne Melo Setter ◽

Andréia Marques Berbel ◽

Antônio Olival Fernandes ◽

...

Keyword(s):

Systematic Review ◽

Cerebral Palsy ◽

Clinical Practice ◽

Upper Limb ◽

Therapeutic Intervention ◽

Movement Therapy ◽

Original Form ◽

Review Of The Literature ◽

Constraint Induced Movement Therapy ◽

Children With Cerebral Palsy

ABSTRACT The purpose of the present study was to perform a systematic review of the literature to investigate how and with what modifications or adaptations constraint-induced movement therapy has been employed in clinical practice for therapeutic interventions in children with cerebral palsy. Searches were conducted of the CAPES (Brazilian fostering agency) periodical portal, Pubmed, Bireme, Science Direct, Scielo and PEDro databases for relevant articles published between January 2010 and May 2016. The articles retrieved were evaluated, scored and qualified by two blinded reviewers using the Physical therapy Evidence Database Scale. The searches led to the retrieval of 102 articles, 12 of which were included in the present systematic review. A table was created containing information on the study groups, inclusion criteria, intervention, intervention frequency, difficulties encountered, evaluations and outcomes. Considerable variety was found in the therapeutic intervention models. The findings of the present review demonstrate that constraint-induced movement therapy in pediatric clinical practice is not employed in its original form. Although the studies analyzed did not have a common methodology regarding the use of this type of therapy, the method has been adapted with considerable flexibility, providing promising, positive results regarding the therapeutic intervention of the paretic upper limb in children with cerebral palsy.

Download Full-text