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

Hira Zafer, Imran Amjad, Arshad Nawaz Malik, Enfall Shaukat, Hira Zafer, Imran Amjad, Arshad Nawaz Malik, Enfall Shaukat

Abstract

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.

Keywords: Bimanual therapy; Constraint induced movement therapy; Hemiplegic Cerebral Palsy.

References

    1. Rosenbaum P, Paneth N, Leviton A, Goldstein M, Bax M, Damiano D, et al. A report: the definition and classification of cerebral palsy April 2006. Dev Med Child Neurol Suppl. 2007;109(Suppl 109):8–14. doi:10.1111/j.1469-8749.2007.tb12610.x.
    1. Reddihough DS, Collins KJ. The epidemiology and causes of cerebral palsy. Australian J Physiotherapy. 2003;49(1):7–12. doi:10.1016/S0004-9514(14)60183-5.
    1. Blair E. Epidemiology of the cerebral palsies. Orthop Clin North Am. 2010;41(4):441–55. doi:10.1111/dmcn.12271.
    1. Minciu I. Cerebral palsy management. Therap Pharmacol Clin Toxicol. 2011;15(2)
    1. Singhi PD. Cerebral palsy-management. Indian J Pediatr. 2004;71(7):635–639.
    1. Krigger KW. Cerebral palsy: an overview. Am Fam Physician. 2006;73(1):91–100.
    1. Levitt S. Treatment of cerebral palsy and motor delay. John Wiley & Sons; 2013.
    1. Gordon AM, Schneider JA, Chinnan A, Charles JR. Efficacy of a hand–arm bimanual intensive therapy (HABIT) in children with hemiplegic cerebral palsy: a randomized control trial. Dev Med Child Neurol. 2007;49(11):830–838. doi:10.1111/j.1469-8749.2011.04066.x.
    1. DeMatteo C, Law M, Russell D, Pollock N, Rosenbaum P, Walter S. The reliability and validity of the Quality of Upper Extremity Skills Test. Physical Occup Ther Pediatr. 1993;13(2):1–18.
    1. Choudhary A, Gulati S, Kabra M, Singh UP, Sankhyan N, Pandey RM, et al. Efficacy of modified constraint induced movement therapy in improving upper limb function in children with hemiplegic cerebral palsy: A randomized controlled trial. Brain Dev. 2013;35(9):870–876. doi:10.1016/j.braindev.2012.11.001.
    1. Sakzewski L, Ziviani J, Abbott DF, Macdonell RA, Jackson GD, Boyd RN. Randomized trial of constraint-induced movement therapy and bimanual training on activity outcomes for children with congenital hemiplegia. Dev Med Child Neurol. 2011;53(4):313–320. doi:10.1016/j.apmr.2010.11.022.
    1. Case-Smith J, DeLuca SC, Stevenson R, Ramey SL. Multicenter randomized controlled trial of pediatric constraint-induced movement therapy:6-month follow-up. Am J Occup Ther. 2012;66(1):15–23. doi:10.5014/ajot.2012.002386.
    1. Aarts PB, Jongerius PH, Geerdink YA, van Limbeek J, Geurts AC. Effectiveness of modified constraint-induced movement therapy in children with unilateral spastic cerebral palsy: a randomized controlled trial. Neurorehab Neural Repair. 2010;24(6):509–518. doi:10.1177/1545968309359767.
    1. Facchin P, Rosa-Rizzotto M, Dalla Pozza LV, Turconi AC, Pagliano E, Signorini S, et al. Multisite trial comparing the efficacy of constraint-induced movement therapy with that of bimanual intensive training in children with hemiplegic cerebral palsy: postintervention results. Am J Phys Med Rehab. 2011;90(7):539–553. doi:10.1097/PHM.0b013e3182247076.
    1. Al-Oraibi S, Eliasson AC. Implementation of constraint-induced movement therapy for young children with unilateral cerebral palsy in Jordan: a home-based model. Disabil Rehab. 2011;33(21-22):2006–12. doi:10.3109/09638288.2011.555594.
    1. Lin KC, Wang TN, Wu CY, Chen CL, Chang KC, Lin YC, et al. Effects of home-based constraint-induced therapy versus dose-matched control intervention on functional outcomes and caregiver well-being in children with cerebral palsy. Res Devel Disabil. 2011;32(5):1483–1491. doi:10.1177/0883073811431011.
    1. Eliasson AC, Sundholm LK, Shaw K, Wang C. Effects of constraint-induced movement therapy in young children with hemiplegic cerebral palsy: an adapted model. Dev Med Child Neurol. 2005;47(4):266–275. doi:10.1111/j.1469-8749.2005.tb01132.x.
    1. Charles J, Gordon AM. Development of hand–arm bimanual intensive training (HABIT) for improving bimanual coordination in children with hemiplegic cerebral palsy. Dev Med Child Neurol. 2006;48(11):931–936. doi:10.1017/S0012162206002039.
    1. Taub E, Uswatte G, Pidikiti R. Constraint-induced movement therapy: a new family of techniques with broad application to physical rehabilitation-a clinical review. J Rehabil Res Dev. 1999;36(3):237–251.
    1. Chan MKL, Tong RKZ, Chung KYK. Bilateral upper limb training with functional electric stimulation in patients with chronic stroke. Neurorehab Neural Repair. 2009;23(4):357–365. doi:10.1177/1545968308326428.

Source: PubMed

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