What is the effect of constraint‐induced movement therapy on children with unilateral cerebral palsy? A Cochrane Review summary with commentary

Introduction The home context is considered a good location for children with cerebral palsy to practise meaningful occupations. The aim of this critical review was to gain a deeper understanding of how bimanual therapy and modified constraint induced movement therapy or constraint induced movement therapy methods are used within occupational therapy home programmes from an occupational perspective. Method A literature search was conducted using electronic databases for health research; five studies met the inclusion criteria. These were critically appraised and were analysed according to the relevant supports and barriers of the person–environment–occupation conceptual model of practice. Findings Family collaboration, strategic use of outcome measures, construction of the programme within the home environment and occupation-focused goals and activities emerged as commonly used methods. Enhanced descriptions of intervention context, the child’s voice in defining goals and challenges in optimising occupational balance surfaced as gaps in the programmes. Conclusion The methods used in implementing these approaches within occupational therapy home programmes requires combining motor and non-motor approaches, core occupational therapy skills, working within individual contexts and valuing family preferences. Using child-specific goal-setting instruments would strengthen the child’s voice and promote participation within a wider range of occupations.

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Efficacy of constraint-induced movement therapy compared with bimanual intensive training in children with unilateral cerebral palsy: a systematic review

Clinical Rehabilitation ◽

10.1177/0269215517698834 ◽

2017 ◽

Vol 31 (11) ◽

pp. 1445-1456 ◽

Cited By ~ 14

Author(s):

MH Tervahauta ◽

GL Girolami ◽

GK Øberg

Keyword(s):

Systematic Review ◽

Cerebral Palsy ◽

Meta Analysis ◽

Movement Therapy ◽

Effect Sizes ◽

System Level ◽

Cochrane Library ◽

Intensive Training ◽

Constraint Induced Movement Therapy ◽

Unilateral Cerebral Palsy

Objective: To systematically review the evidence on the effect of constraint-induced movement therapy compared with bimanual intensive training in children with unilateral cerebral palsy. Data sources: Seven electronic databases (Cinahl, Cochrane Library, EMBASE, Ovid MEDLINE, PEDro, PsycINFO, PubMed) were searched from database inception through December 2016. Methods: A systematic review was performed using the American Academy of Cerebral Palsy and Developmental Medicine and Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Standardised mean differences (effect sizes) were calculated for each study and outcome. Results: Nine studies met the eligibility criteria. All studies provided level II evidence. Methodological quality was high in two studies, moderate in four studies and low in three studies. The methodology, participant and intervention characteristics were heterogeneous. The participants’ ages ranged from 1.5 to 16 years. Their initial hand function ranged from Manual Ability Classification System Level I to Level III. The total intervention dose ranged from 24 to 210 hours and duration from one week to ten weeks. The studies measured outcomes assessing unimanual and bimanual hand and arm function, participation and attainment of individualised goals. Overall, the effect sizes did not favour one of the interventions at short- or long-term follow-up. The 95% confidence intervals were broad, indicating inaccurate precision of the effect sizes. Pooling of the data for a meta-analysis was judged to be of little clinical value owing to heterogeneity. Conclusion: It is not possible to conclude whether constraint-induced movement therapy or bimanual intensive training is more effective than the other in children with unilateral cerebral palsy.

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