The effect of modified constraint-induced movement therapy in children with hemiparetic cerebral palsy. Consecutive or intermittent days?

Is more always better? Effectiveness of constraint-induced movement therapy in children with high-risk or unilateral cerebral palsy (0-6 years): Systematic review and meta-analysis

BACKGROUND

While constraint-induced movement therapy is strongly recommended as an intervention for infants with unilateral cerebral palsy, the optimal dosage remains undefined. This systematic review aims to identify the most effective level of intensity of constraint-induced movement therapy to enhance manual function in infants at high risk of asymmetric brain lesions or unilateral cerebral palsy diagnosis.

METHODS

This systematic review with meta-analysis encompassed a comprehensive search across four electronic databases to identify articles that met the following criteria: randomised controlled trials, children aged 0-6 with at high risk or with unilateral cerebral palsy, and treatment involving constraint-induced movement therapy for upper limb function. Studies with similar outcomes were pooled by calculating the standardised mean difference score for each subgroup, and subgroups were stratified every 30 h of total intervention dosage (30-60, 61-90, >90 h). Risk of bias was assessed with Cochrane Collaboration's tool.

RESULTS

Seventeen studies were included. Meta-analyses revealed significant differences among subgroups. The 30-60 h subgroup showed a weak effect for spontaneous use of the affected upper limb during bimanual performance, grasp function, and parents' perception of how often children use their affected upper limb. Additionally, this subgroup demonstrated a moderate effect for the parents' perception of how effectively children use their affected upper limb.

CONCLUSIONS

Using a dosage ranging from 30 to 60 h when applying a constraint-induced movement therapy protocol holds promise as the most age-appropriate and cost-effectiveness approach for improving upper limb functional outcomes and parent's perception.

Modified-constraint movement induced therapy versus neuro-developmental therapy on reaching capacity in children with hemiplegic cerebral palsy

BACKGROUND AND OBJECTIVE

Upper extremity impairment is one of the complications in hemiplegic children. The purpose of modified constraint-induced movement therapy (mCIMT) is to improve the function of impaired arms and hands in these children. This study compared the efficacy of mCIMT and the approach of neurodevelopmental therapy (NDT) on reaching capacity in children with spastic hemiplegia.

METHODS

Fifty-two spastic hemiplegic children ranging in age from four to 6 years were selected for this study from an outpatient clinic and biomechanical lab (Prince Sattam bin Abdulaziz University, KSA). They were randomly divided into two experimental groups: group I received NDT and group II received mCIMT for the involved upper limb and restriction of the uninvolved arm movements for 12 weeks (three times per week). Both groups received a conventional exercise program in addition to experimental one. Active elbow extension range of motion and three-dimensional motion analysis of the reaching task were measured before and after 3 months of treatment.

RESULTS

Significant enhancement in all pre-treatment and post-treatment outcomes was observed in both groups by a two-way mixed MANOVA; furthermore, Group II (mCIMT) showed the most significant improvement (elbow extension, percentage of reach to peak velocity, movement time and movement units) when comparing the post-treatment outcomes between the two groups (p < 0.001).

IMPLICATION FOR PHYSIOTHERAPY PRACTICE

Addition of mCIMT to a conventional exercise was superior to adding NDT exercise therapy in promoting the performance of reaching pattern in hemiplegic children.