Adapted version of constraint-induced movement therapy promotes functioning in children with cerebral palsy: a randomized controlled trial

Objective: To evaluate the effects of constraint-induced movement therapy on the use of the affected arm and on daily functioning in children with hemiplegic cerebral palsy. Design: A single-blinded randomized clinical trial. Subjects: Sixteen children with cerebral palsy randomized to intervention (n = 8, 4 males, 4 females, mean age 5 years and 6 months) and control groups (n = 8, 4 males, 4 females, mean age 6 years and 7 months). Interventions: Non-affected arm of intervention group was restricted for 10 hours/day and the affected arm intensively trained for 3 hours/day for two weeks. The intervention protocol included one week of bimanual functional training following constraint therapy. The control group maintained usual rehabilitation throughout the intervention period. Main measures: Pediatric Evaluation of Disability Inventory (self-care domain) and an adapted version of the Jebsen-Taylor test were administered before and after intervention, and at one month follow-up. General linear models tested differences in gain scores and the number needed to treat estimated relative effectiveness of intervention protocol for functional skills and independence in self-care. Results: Results are reported for 15 children who completed assessments and intervention. Higher gains were observed in the intervention group for functional skills and independence post intervention (d(functional skills) = 1.61, P=0.0134; d(independence)=1.37; P=0.0001) and follow-up (d(functional skills)=2.08, P=0.004; d(independence)=0.85; P=0.0016). No group difference in manual dexterity gains was observed. Low indices of number needed to treat (1.75 and 2.33) illustrate clinical relevance of intervention. Conclusions: The protocol associating constraint-induced movement therapy and bimanual functional training was effective in promoting daily living functioning among children with cerebral palsy.