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Neuropediatrics 2025; 56(05): 281-301
DOI: 10.1055/a-2616-4893
Review Article

Effect of Modified Constraint-Induced Movement Therapy on Upper Limb Function in Children with Hemiplegic Cerebral Palsy

Ehab Mohamed Abd El-Kafy 
1   Department of Medical Rehabilitation Sciences, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia
,
Nahla Ahmad Almatrafi 
2   Department of Rehabilitation, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
,
Mohamed Salaheldien Alayat 
1   Department of Medical Rehabilitation Sciences, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia
,
Nawal Alami Tawhari 
3   Department of Rehabilitation, Samtah General Hospital, Ministry of Health, Jazan, Saudi Arabia
,
Najwa Fawzi Abuallam 
4   Department of Rehabilitation, Abha Maternity and Children Hospital, Ministry of Health, Abha, Saudi Arabia
,
Hayam Mahmoud Mahmoud 
1   Department of Medical Rehabilitation Sciences, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia
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Abstract

To assess the effectiveness of modified constraint-induced movement therapy (mCIMT) in improving upper limb function and grip strength in children with hemiplegic cerebral palsy (CP). A comprehensive search was conducted from inception to August 2024. Eligibility criteria were studies evaluating the effectiveness of mCIMT on upper limb function in children with hemiplegic CP aged over 2 years. The following data was extracted from each study: participant characteristics, intervention, outcome measures, follow-up, and key findings. The risk of bias and the quality of the evidence were evaluated using the PEDro scale and the grading of recommendations assessment development and evaluation (GRADE), respectively. A meta-analysis using a random-effect model was performed, and standardized mean difference (SMD) with a 95% confidence interval (CI) was estimated for upper limb function and grip strength. A total of 25 studies (1,115 children) were included. PEDro scale revealed 12 good-quality studies, 8 fair-quality studies, and 5 poor-quality studies. The currently available evidence showed a significant large effect of mCIMT in improving upper limb function (SMD: 1.14 [95% CI: 0.46–1.83]; p = 0.001; 12 studies; 454 children; very-low-quality evidence) and significant medium effect in improving grip strength (SMD: 0.63 [95% CI: 0.12–1.14]; p = 0.02; 3 studies; 92 children; low-quality evidence). mCIMT could improve upper limb function and grip strength in children with hemiplegic CP. However, due to the low and very low quality of evidence, further high-quality trials are needed to confirm these effects. PROSPERO registration number (CRD42023413525).

Keywords

modified constraint-induced movement therapy - mCIMT - upper limb - rehabilitation - hemiplegic cerebral palsy

Authors' Contribution

All authors contributed to the study conception and design and material preparation, data collection, and analysis and read and approved the final manuscript. The first draft of the manuscript was written by E.A.E.K. and N.A. and all authors commented on previous versions of the manuscript. E.A.E.K. had the idea for the article, reviewed the literature search and data analysis, and drafted and/or critically revised the work.


E.A.E.K.: Study conception and design, project administration and supervision, methodology (evaluate the methodological quality and quality of evidence), and writing (the first draft).


Nahla Almatrafi: Investigation (assessing the articles for relevance and reviewing the extracted data from articles), methodology (evaluating the methodological quality), and writing (revising and editing the first draft).


M.A.: Registration process on the PROSPERO, methodology (evaluate the methodological quality and quality of evidence), and formal analysis (meta-analysis software).


H.M.: Formal analysis (review the founded articles for eligibility and remove duplication by endnote), investigation (assessing the articles for relevance and reviewing the extracted data from articles), validation in the methodological quality (a third reviewer), and writing (revised and editing the first draft).


N.T. and Najwa Abuallam: Searching for the included articles using the keywords in different databases, methodology (data extraction for included articles), and methodology (data extraction for included articles).


Supplementary Material



Publication History

Received: 14 February 2025

Accepted: 14 May 2025

Accepted Manuscript online:
20 May 2025

Article published online:
04 June 2025

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