Background: While adults with hemiplegic cerebral palsy (CP) can have significant upper limb dysfunction, the effects of movement-based training has not been investigated. Objective: This uncontrolled trial assessed the effects of a home and internet-based upper limb intervention program targeting motor and sensory function. Methods: Twelve adults, aged 21 to 57 yrs, GMFCS levels I-III with asymmetric upper limb involvement participated in the Upper Limb Training and Assessment (ULTrA) program. Clinical and functional measures included the Motor Activity Log (MAL), the Nine-Hole Peg test, and grip strength. An upper limb training system consisting of a laptop, webcam, target light board, and hand manipulation/ discrimination devices was installed in each participant’s home. Training occurred 40 min/day, 5 days/wk for 8 wks and included both unilateral and bilateral reach movements as well as a series of hand sensorimotor tasks such as card turning, stereognosis, and tactile discrimination. Data generated during each session were transmitted to the laboratory via the Internet. Main outcome measures were movement time, interlimb delay time, and performance on hand sensorimotor tasks. Results: Following training, affected limb reach movement time decreased significantly for unilateral and bilateral tasks. Interlimb delay during sequential reaching also decreased. Significant improvement in hand manipulation tasks was also seen. Compliance was excellent and there were no adverse effects. Conclusion: The ULTrA program had beneficial effects for adults with CP and is safe and convenient to use. This system contrasts sharply with programs with similar intent that require participant travel and hours of therapist-based intervention.
Blanton S., Wilsey H., Wolf SLConstraint-induced movement therapy in stroke rehabilitation: perspectives on future clinical applications. NeuroRehabilitation. 2008;23:15-28.
2.
Gordon AM, Charles J., Wolf SLMethods of constraint-induced movement therapy for children with hemiplegic cerebral palsy: development of a child-friendly intervention for improving upper-extremity function. Arch Phys Med Rehabil. 2005;86: 837-844.
3.
Gordon AM, Charles J., Wolf SLEfficacy of constraint-induced movement therapy on involved upper-extremity use in children with hemiplegic cerebral palsy is not age-dependent. Pediatrics. 2006;117:e363-e373.
4.
Hoare B., Imms C., Carey L., Wasiak J.Constraint-induced movement therapy in the treatment of the upper limb in children with hemiplegic cerebral palsy: a Cochrane systematic review. Clin Rehabil. 2007;21:675-685.
5.
Taub E., Griffin A., Nick J., Gammons K., Uswatte G., Law CRPediatric CI therapy for stroke-induced hemiparesis in young children. Dev Neurorehabil. 2007;10:3-18.
6.
Chen YP, Yang TFEffect of task goals on the reaching patterns of children with cerebral palsy . J Mot Behav. 2007;39:317-324.
7.
Fetters L., Kluzik J.The effects of neurodevelopmental treatment versus practice on the reaching of children with spastic cerebral palsy. Phys Ther. 1996;76:346-358.
8.
Eliasson AC, Gordon AMImpaired force coordination during object release in children with hemiplegic cerebral palsy. Dev Med Child Neurol. 2000 ;42:228-234.
9.
Steenbergen B., Charles J., Gordon AMFingertip force control during bimanual object lifting in hemiplegic cerebral palsy. Exp Brain Res. 2008;186:191-201.
10.
Hurvitz EA, Conti GE, Brown SHChanges in movement characteristics of the spastic upper extremity after botulinum toxin injection. Arch Phys Med Rehabil. 2003 ;84:444-454.
11.
Hung YC, Charles J., Gordon AMBimanual coordination during a goal-directed task in children with hemiplegic cerebral palsy. Dev Med Child Neurol. 2004 ;46:746-753.
12.
Steenbergen B., Gordon A.Activity limitation in hemiplegic cerebral palsy: evidence for disorders in motor planning. Dev Med Child Neurol. 2006;48:780-783.
13.
Gordon AM, Schneider JA, Chinnan A., Charles JREfficacy of a hand-arm bimanual intensive therapy (HABIT) in children with hemiplegic cerebral palsy: a randomized control trial. Dev Med Child Neurol. 2007;49:830-838.
14.
Butefisch C. , Hummelsheim H., Denzler P., Mauritz KHRepetitive training of isolated movements improves the outcome of motor rehabilitation of the centrally paretic hand . J Neurol Sci. 1995;130:59-68.
15.
Stewart JC, Yeh SC, Jung Y., et al. Intervention to enhance skilled arm and hand movements after stroke: a feasibility study using a new virtual reality system. J Neuroeng Rehabil. 2007;4:21.
16.
Thielman GT, Dean CM, Gentile AMRehabilitation of reaching after stroke: task-related training versus progressive resistive exercise. Arch Phys Med Rehabil. 2004;85:1613-1618.
17.
Page SJ, Levine P.Modified constraint-induced therapy extension: using remote technologies to improve function. Arch Phys Med Rehabil. 2007 ;88:922-927.
18.
Taub E., Lum PS, Hardin P., Mark VW, Uswatte G.AutoCITE: automated delivery of CI therapy with reduced effort by therapists . Stroke. 2005;36:1301-1304.
19.
Jahnsen R., Villien L., Egeland T., Stanghelle JK, Holm I.Locomotion skills in adults with cerebral palsy. Clin Rehabil . 2004;18:309-316.
20.
Park SW, Wolf SL, Blanton S., Winstein C., Nichols-Larsen DSThe EXCITE Trial: predicting a clinically meaningful motor activity log outcome . Neurorehabil Neural Repair. 2008;22: 486-493.
21.
Luft AR, McCombe-Waller S., Whitall J., et al. Repetitive bilateral arm training and motor cortex activation in chronic stroke: a randomized controlled trial. JAMA. 2004;20:1853-61.
22.
Naylor CE, Bower E.Modified constraint-induced movement therapy for young children with hemiplegic cerebral palsy: a pilot study. Dev Med Child Neurol. 2005;47:363-369.
23.
Byl N., Leano J., Cheney LKThe Byl-Cheney-Boczai Sensory Discriminator: reliability, validity, and responsiveness for testing stereognosis. J Hand Ther. 2002 ;15:315-330.
24.
Cohen J.Statistical PowerAnalysis for the Behavioral Sciences. 2nd ed. Hillsdale, NJ: Lawrence Erlbaum; 1988.
25.
Kairy D., Lehoux P., Vincent C., Visintin M.A systematic review of clinical outcomes, clinical process, healthcare utilization and costs associated with telerehabilitation. Disabil Rehabil . 2009;31:427-447.
26.
Morelli S., Maccioni G., Lanzetta M., Macellari V., Giansanti D.A home-care system for the telemonitoring and telerehabilitation of the hand incorporating interactive biofeedback. J Telemed Telecare . 2008;14:372-376.
27.
Szturm T., Peters JF, Otto C., Kapadia N., Desai A.Task-specific rehabilitation of finger-hand function using interactive computer gaming. Arch Phys Med Rehabil. 2008;89:2213-2217.
28.
Eliasson AC , Krumlinde-Sundholm L., 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;47:266-275.
29.
Krumlinde-Sundholm L., Holmefur M., Kottorp A., Eliasson A.The Assisting Hand Assessment: current evidence of validity, reliability, and responsiveness to change. Dev Med Child Neurol. 2007;49:259-264.
30.
Byl N., Roderick J., Mohamed O., et al. Effectiveness of sensory and motor rehabilitation of the upper limb following the principles of neuroplasticity: patients stable poststroke . Neurorehabil Neural Repair. 2003;17:176-191.
31.
Charles J., Gordon AMDevelopment of hand-arm bimanual intensive training (HABIT) for improving bimanual coordination in children with hemiplegic cerebral palsy. Dev Med Child Neurol. 2006;48:931-936.
32.
Lin KC, Chang YF, Wu CY, Chen YAEffects of constraint-induced therapy versus bilateral arm training on motor performance, daily functions, and quality of life in stroke survivors. Neurorehabil Neural Repair. 2009;23:441-448.
33.
McCombe Waller S., Harris-Love M., Liu W., Whitall J.Temporal coordination of the arms during bilateral simultaneous and sequential movements in patients with chronic hemiparesis . Exp Brain Res. 2006;168:450-454.
34.
Sugden D., Utley A.Interlimb coupling in children with hemiplegic cerebral palsy. Dev Med Child Neurol. 1995;37:293-309.
35.
Rice MS, Newell KMUpper-extremity interlimb coupling in persons with left hemiplegia due to stroke. Arch Phys Med Rehabil. 2004;85:629-634.
36.
Steenbergen B., Hulstijn W., de Vries A., Berger M.Bimanual movement coordination in spastic hemiparesis. Exp Brain Res. 1996;110:91-98.
37.
Utley A., Sugden D.Interlimb coupling in children with hemiplegic cerebral palsy during reaching and grasping at speed. Dev Med Child Neurol. 1998;40:396-404.
38.
Van Heest AE , House J., Putnam M.Sensibility deficiencies in the hands of children with spastic hemiplegia. J Hand Surg Am. 1993 ;18:278-281.
39.
Wingert JR, Burton H., Sinclair RJ, Brunstrom JE, Damiano DLTactile sensory abilities in cerebral palsy: deficits in roughness and object discrimination. Dev Med Child Neurol. 2008 ;50:832-838.
40.
Byl NN, Nagajaran S., McKenzie ALEffect of sensory discrimination training on structure and function in patients with focal hand dystonia: a case series. Arch Phys Med Rehabil . 2003;84:1505-1514.
41.
Johansson R.Dynamic use of tactile afferent signals in control of dexterous manipulation. Adv Exp Med Biol. 2002;508:397-410.
42.
Andersson C. , Mattsson E.Adults with cerebral palsy: a survey describing problems, needs, and resources, with special emphasis on locomotion. Dev Med Child Neurol. 2001;43:76-82.
43.
Strauss D., Ojdana K., Shavelle R., Rosenbloom L.Decline in function and life expectancy of older persons with cerebral palsy . NeuroRehabilitation. 2004;19:69-78.
44.
Ando N., Ueda S.Functional deterioration in adults with cerebral palsy. Clin Rehabil. 2000;14:300-306.
45.
Heller T., Ying Gs GS, Rimmer JH, Marks BADeterminants of exercise in adults with cerebral palsy. Public Health Nurs. 2002;19:223-231.
46.
Charles JR, Gordon AMA repeated course of constraint-induced movement therapy results in further improvement. Dev Med Child Neurol. 2007;49:770-773.
