Sage Journals: Discover world-class research

Abstract

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.

Keywords

Hemiplegic cerebral palsy constraint-induced movement therapy upper limb rehabilitation therapy randomized controlled trial

Get full access to this article

View all access options for this article.

References

Surman

Bonellie

Chalmers

et al . UKCP: a collaborative network of cerebral palsy registers in the United Kingdom. J Public Health 2006; 28: 148–156.

Sanger

Delgado

Gaebler

et al . Classification and definition of disorders causing hypertonia in childhood. Pediatrics 2003; 111: e89–e97.

Krumlinde-Sundholm

Eliasson

AC.

Comparing tests of tactile sensibility: aspects relevant to testing children with spastic hemiplegia. Dev Med Child Neurol 2002; 44: 604–612.

Eliasson

Gordon

Forssberg

Tactile control of isometric fingertip forces during grasping in children with cerebral palsy. Dev Med Child Neurol 1995; 37: 72–84.

Eliasson

Gordon

AM.

Impaired force coordination during object release in children with hemiplegic cerebral palsy. Dev Med Child Neurol 2000; 42: 228–234.

Taub

Ramey

DeLuca

et al . Efficacy of constraint-induced movement therapy for children with cerebral palsy with asymmetric motor impairment. Pediatrics 2004; 113: 305–312.

Beecham

O’Neill

Goodman

Supporting young adults with hemiplegia: services and costs. Health Soc Care Community 2001; 9: 51–59.

Sakzewski

Ziviani

Boyd

Systematic review and meta-analysis of therapeutic management of upper-limb dysfunction in children with congenital hemiplegia. Pediatrics 2009; 123: e1111–e1122.

Boyd

Morris

Graham

HK.

Management of upper limb dysfunction in children with cerebral palsy: a systematic review. Eur J Neurol 2001; 8: 150–166.

10.

Taub

Uswatte

Pidikiti

Constraint-induced movement therapy: a new family of techniques with broad application to physical rehabilitation – a clinical review. J Rehabil Res Dev 1999; 36: 237–251.

11.

Taub

Miller

Novack

TA.

Technique to improve chronic motor deficit after stroke. Arch Phys Med Rehabil 1993; 74: 347–354.

12.

Hoare

Imms

Carey

et al . Constraint-induced movement therapy in the treatment of the upper limb in children with hemiplegic cerebral palsy. Clin Rehabil 2007; 8: 675–685.

13.

Huang

Fetters

Hale

et al . Bound for success: a systematic review of constraint-induced movement therapy in children with cerebral palsy supports improved arm and hand use. Phys Ther 2009; 89: 1126–1141.

14.

Eliasson

Krumlinde-Sundholm

Gordon

et al . Guidelines for future research in constraint-induced movement therapy for children with unilateral cerebral palsy: an expert consensus. Dev Med Child Neurol 2013; 56: 125–137.

15.

Wallen

Ziviani

Naylor

et al . Modified constraint-induced therapy for children with hemiplegic cerebral palsy: a randomized trial. Dev Med Child Neurol 2011; 53: 1091–1099.

16.

Eliasson

Shaw

Berg

et al . An ecological approach of constraint induced movement therapy for 2–3-year-old children: a randomized control trial. Res Dev Disabil 2011; 32: 2820–2828.

17.

Al-Oraibi

Eliasson

AC.

Implementation of constraint-induced movement therapy for young children with unilateral cerebral palsy in Jordan: a home-based model. Disabil Rehabil 2011; 33: 2006–2015.

18.

Krumlinde-Sundholm

Holmefur

Kottorp

et al . The Assisting Hand Assessment: current evidence of validity, reliability, and responsiveness to change. Dev Med Child Neurol 2007; 49: 259–264.

19.

Krumlinde-Sundholme

Eliasson

AC.

Development of the Assisting Hand Assessment, a Rasch-built measure intended for children with unilateral upper limb impairments. Scand J Occup Ther 2003; 10: 16–26.

20.

Holmefur

Aarts

Hoare

et al . Test-retest and alternate forms reliability of the Assisting Hand Assessment. J Rehabil Med 2009; 41: 886–891.

21.

DeMatteo

Law

Russell

et al . Quality of Upper Extremity Skills Test manual. Hamilton, ON, Canada: McMaster University, CanChild Centre for Childhood Disability Research, 1992.

22.

DeMatteo

Law

Russell

et al . The reliability and validity of the quality of upper extremity skills test. Phys Occup Ther Pediatr 1993; 13: 1–18.

23.

Varni

Seid

Rode

CA.

The PedsQL: measurement model for the Pediatric Quality Of Life Inventory. Med Care 1999; 37: 126–139.

24.

Varni

Burwinkle

Berrin

et al . The PedsQL in pediatric cerebral palsy: reliability, validity, and sensitivity of the generic core scales and cerebral palsy module. Dev Med Child Neurol 2006; 48: 442–449.

25.

Varni

Limbers

Neighbors

et al . The PedsQLTM infant scales: feasibility, internal consistency reliability, and validity in healthy and ill infants. Qual Life Res 2011; 20: 45–55.

26.

Siemonsma

Walker

MF.

Practical guidelines for independent assessment in randomized controlled trials of rehabilitation. Clin Rehabil 1997; 11: 273–279.

27.

Minns Lowe

Wilson

Sackley

et al . Blind outcome assessment: the development and use of procedures to maintain and describe blinding in a pragmatic physiotherapy rehabilitation trial. Clin Rehabil 2011; 25: 264–274.

28.

Naylor

Bower

Modified constraint-induced movement therapy for young children with hemiplegic cerebral palsy: a pilot study. Dev Med Child Neurol 2005; 47: 365–369.

29.

Eliasson

Krumlinde-Sundholm

Shaw

et al . Effects of constraint-induced movement therapy in young children with hemiplegic cerebral palsy: an adapted model. Dev Med Child Neurol 2005; 47: 266–275.

30.

Kwakkel

van Peppen

Wagenaar

et al . Effects of augmented exercise time after stroke: a meta-analysis. Stroke 2004; 35: 2529–2539.

31.

Veerbeek

Koolstra

Ket

et al . Effects of augmented exercise therapy on outcome of gait and gait-related activities in the first 6 months after stroke: a meta-analysis. Stroke 2011; 42: 3311–3315.

32.

Case-Smith

Deluca

Stevenson

et al . Multicenter randomized controlled trial of pediatric constraint-induced movement therapy: 6-month follow-up. Am J Occupther 2012; 66: 15–23.

33.

Deluca

Echols

Law

et al . Intensive pediatric constraint-induced therapy for children with cerebral palsy: randomized, controlled, crossover trial. J Child Neurol 2006; 21: 931–938.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.64 MB

A randomized controlled trial to compare two methods of constraint-induced movement therapy to improve functional ability in the affected upper limb in pre-school children with hemiplegic cerebral palsy: CATCH TRIAL

Abstract

Objective:

Design:

Setting:

Subjects:

Interventions:

Main measures:

Results:

Conclusion:

Keywords

Get full access to this article

References

Supplementary Material