Download PDF
Neuropediatrics 2020; 51(04): 259-266
DOI: 10.1055/s-0040-1702220
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Effects of Modified Constraint-Induced Movement Therapy in Real-World Arm Use in Young Children with Unilateral Cerebral Palsy: A Single-Blind Randomized Trial

Young Sub Hwang
1   Department of Physical and Rehabilitation Medicine, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
,
Jeong-Yi Kwon
1   Department of Physical and Rehabilitation Medicine, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
› Author Affiliations
Further Information

Publication History

19 August 2019

12 January 2020

Publication Date:
06 March 2020 (online)

    Permissions and Reprints

Abstract

Objective To determine whether modified constraint-induced movement therapy (mCIMT) with continuous restraint is feasible and effective in improving the use of the paretic arm in the real world among infants and toddlers with unilateral cerebral palsy (CP).

Design Single-blind randomized controlled trial.

Setting Tertiary hospital.

Participants Children aged 7 to 36 months with unilateral CP (N = 24; 16 boys, 8 girls).

Intervention The experimental group received 2-hour clinic-based mCIMT sessions (5 days per week for 3 weeks), and a continuous restraint was applied.

Main Outcome Measures Standardized assessments were conducted. Peabody Developmental Motor Scales-2 (PDMS-2), Gross Motor Function Measure-66, Pediatric Motor Activity Log (PMAL), and Pediatric Evaluation of Disability Inventory were measured pre- and postintervention. Children who agreed to participate in the accelerometer study additionally wore accelerometers on both their wrists for 3 days before and after the intervention.

Results The mCIMT group exhibited greater improvement in PMAL-how often (p = 0.048; ηp2 = 0.173), PMAL-how well (p = 0.008; ηp2 = 0.289), and PDMS-2 visual motor integration (p = 0.014; ηp2 = 0.256) posttreatment than the control group. The percentage of time in moderate-to-vigorous physical activity (z = –2.24; p = 0.03) and vector magnitude average counts (z = –2.52; p = 0.01) significantly increased in children in who wore accelerometers (N = 8) after the 3-week mCIMT protocol.

Conclusion mCIMT with continuous restraint applied to infants and toddlers with unilateral CP appeared to have a positive effect on paretic hand use in the real world.

Clinical Trial Registration Number NCT03418519

Keywords

constraint-induced movement therapy - unilateral cerebral palsy - accelerometer - infants - toddlers

Supplementary Material

 

  • References

  • 1 Rosenbaum P, Paneth N, Leviton A. , et al. A report: the definition and classification of cerebral palsy April 2006. Dev Med Child Neurol Suppl 2007; 109: 8-14
    PubMedGoogle Scholar
  • 2 Johnson A. Prevalence and characteristics of children with cerebral palsy in Europe. Dev Med Child Neurol 2002; 44 (09) 633-640
    PubMedGoogle Scholar
  • 3 Kuhtz-Buschbeck JP, Sundholm LK, Eliasson AC, Forssberg H. Quantitative assessment of mirror movements in children and adolescents with hemiplegic cerebral palsy. Dev Med Child Neurol 2000; 42 (11) 728-736
    CrossrefPubMedGoogle Scholar
  • 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 (08) 675-685
    CrossrefPubMedGoogle Scholar
  • 5 Taub E, Ramey SL, DeLuca S, Echols K. Efficacy of constraint-induced movement therapy for children with cerebral palsy with asymmetric motor impairment. Pediatrics 2004; 113 (02) 305-312
    CrossrefPubMedGoogle Scholar
  • 6 Sutcliffe TL, Gaetz WC, Logan WJ, Cheyne DO, Fehlings DL. Cortical reorganization after modified constraint-induced movement therapy in pediatric hemiplegic cerebral palsy. J Child Neurol 2007; 22 (11) 1281-1287
    CrossrefPubMedGoogle Scholar
  • 7 DeLuca SC, Case-Smith J, Stevenson R, Ramey SL. Constraint-induced movement therapy (CIMT) for young children with cerebral palsy: effects of therapeutic dosage. J Pediatr Rehabil Med 2012; 5 (02) 133-142
    PubMedGoogle Scholar
  • 8 Uswatte G, Taub E, Griffin A, Vogtle L, Rowe J, Barman J. The Pediatric Motor Activity Log-revised: assessing real-world arm use in children with cerebral palsy. Rehabil Psychol 2012; 57 (02) 149-158
    CrossrefPubMedGoogle Scholar
  • 9 de Vries SI, Bakker I, Hopman-Rock M, Hirasing RA, van Mechelen W. Clinimetric review of motion sensors in children and adolescents. J Clin Epidemiol 2006; 59 (07) 670-680
    CrossrefPubMedGoogle Scholar
  • 10 O'Neil ME, Fragala-Pinkham M, Lennon N, George A, Forman J, Trost SG. Reliability and validity of objective measures of physical activity in youth with cerebral palsy who are ambulatory. Phys Ther 2016; 96 (01) 37-45
    CrossrefPubMedGoogle Scholar
  • 11 Oftedal S, Bell KL, Davies PS, Ware RS, Boyd RN. Validation of accelerometer cut points in toddlers with and without cerebral palsy. Med Sci Sports Exerc 2014; 46 (09) 1808-1815
    CrossrefPubMedGoogle Scholar
  • 12 Coker-Bolt P, Downey RJ, Connolly J, Hoover R, Shelton D, Seo NJ. Exploring the feasibility and use of accelerometers before, during, and after a camp-based CIMT program for children with cerebral palsy. J Pediatr Rehabil Med 2017; 10 (01) 27-36
    PubMedGoogle Scholar
  • 13 Friel K, Chakrabarty S, Kuo HC, Martin J. Using motor behavior during an early critical period to restore skilled limb movement after damage to the corticospinal system during development. J Neurosci 2012; 32 (27) 9265-9276
    CrossrefPubMedGoogle Scholar
  • 14 Yakovlev PL, Lecours AR. The myelogenetic cycles of regional maturation of the brain. In: Minkowski A. , ed. Regional Development of the Brain in Early Life. Oxford: Blackwell; 1967: 3-70
    Google Scholar
  • 15 Morris DM, Taub E, Mark VW. Constraint-induced movement therapy: characterizing the intervention protocol. Eura Medicophys 2006; 42 (03) 257-268
    PubMedGoogle Scholar
  • 16 Deluca SC, Echols K, Law CR, Ramey SL. Intensive pediatric constraint-induced therapy for children with cerebral palsy: randomized, controlled, crossover trial. J Child Neurol 2006; 21 (11) 931-938
    CrossrefPubMedGoogle Scholar
  • 17 Uswatte G, Taub E, Morris D, Light K, Thompson PA. The Motor Activity Log-28: assessing daily use of the hemiparetic arm after stroke. Neurology 2006; 67 (07) 1189-1194
    CrossrefPubMedGoogle Scholar
  • 18 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 (03) 237-251
    PubMedGoogle Scholar
  • 19 Miltner WH, Bauder H, Sommer M, Dettmers C, Taub E. Effects of constraint-induced movement therapy on patients with chronic motor deficits after stroke: a replication. Stroke 1999; 30 (03) 586-592
    CrossrefPubMedGoogle Scholar
  • 20 Folio MR, Fewell RR. Peabody Developmental Motor Scales: Examiner's Manual. Austin, TX: PRO-ED; 2000
    Google Scholar
  • 21 Russell DJ, Rosenbaum PL, Wright M, Avery LM. Gross Motor Function Measure (GMFM-66 & GMFM-88) User's Manual. London: Mac Keith Press; 2002
    Google Scholar
  • 22 Haley SM. Pediatric Evaluation of Disability Inventory (PEDI): Development, Standardization and Administration Manual. Boston, MA: PEDI Research Group; 1992
    Google Scholar
  • 23 Hsin YJ, Chen FC, Lin KC, Kang LJ, Chen CL, Chen CY. Efficacy of constraint-induced therapy on functional performance and health-related quality of life for children with cerebral palsy: a randomized controlled trial. J Child Neurol 2012; 27 (08) 992-999
    CrossrefPubMedGoogle Scholar
  • 24 Lin KC, Chen HF, Chen CL. , et al. Validity, responsiveness, minimal detectable change, and minimal clinically important change of the Pediatric Motor Activity Log in children with cerebral palsy. Res Dev Disabil 2012; 33 (02) 570-577
    CrossrefPubMedGoogle Scholar
  • 25 Cohen J. Statistical Power Analysis for the Behavioral Sciences. 2nd ed. Hillsdale, NJ: Lawrence Erlbaum Associates; 1988
    Google Scholar
  • 26 Eliasson AC, Nordstrand L, Ek L. , et al. The effectiveness of Baby-CIMT in infants younger than 12 months with clinical signs of unilateral-cerebral palsy; an explorative study with randomized design. Res Dev Disabil 2018; 72: 191-201
    CrossrefPubMedGoogle Scholar
  • 27 van der Pas SC, Verbunt JA, Breukelaar DE, van Woerden R, Seelen HA. Assessment of arm activity using triaxial accelerometry in patients with a stroke. Arch Phys Med Rehabil 2011; 92 (09) 1437-1442
    CrossrefPubMedGoogle Scholar
  • 28 Sokal B, Uswatte G, Vogtle L, Byrom E, Barman J. Everyday movement and use of the arms: relationship in children with hemiparesis differs from adults. J Pediatr Rehabil Med 2015; 8 (03) 197-206
    PubMedGoogle Scholar
  • 29 Nordstrand L, Holmefur M, Kits A, Eliasson AC. Improvements in bimanual hand function after baby-CIMT in two-year old children with unilateral cerebral palsy: a retrospective study. Res Dev Disabil 2015; 41-42: 86-93
    CrossrefPubMedGoogle Scholar
  • 30 Iglowstein I, Jenni OG, Molinari L, Largo RH. Sleep duration from infancy to adolescence: reference values and generational trends. Pediatrics 2003; 111 (02) 302-307
    CrossrefPubMedGoogle Scholar
  • 31 Martin JH, Choy M, Pullman S, Meng Z. Corticospinal system development depends on motor experience. J Neurosci 2004; 24 (09) 2122-2132
    CrossrefPubMedGoogle Scholar
  • 32 Popkin CA, Levine WN, Ahmad CS. Evaluation and management of pediatric proximal humerus fractures. J Am Acad Orthop Surg 2015; 23 (02) 77-86
    CrossrefPubMedGoogle Scholar
  • 33 Lowes LP, Mayhan M, Orr T. , et al. Pilot study of the efficacy of constraint-induced movement therapy for infants and toddlers with cerebral palsy. Phys Occup Ther Pediatr 2014; 34 (01) 4-21
    CrossrefPubMedGoogle Scholar
  • 34 Fergus A, Buckler J, Farrell J, Isley M, McFarland M, Riley B. Constraint-induced movement therapy for a child with hemiparesis: a case report. Pediatr Phys Ther 2008; 20 (03) 271-283
    CrossrefPubMedGoogle Scholar
  • 35 Cope SM, Forst HC, Bibis D, Liu XC. Modified constraint-induced movement therapy for a 12-month-old child with hemiplegia: a case report. Am J Occup Ther 2008; 62 (04) 430-437
    CrossrefPubMedGoogle Scholar
  • 36 DeLuca SC, Echols K, Ramey SL, Taub E. Pediatric constraint-induced movement therapy for a young child with cerebral palsy: two episodes of care. Phys Ther 2003; 83 (11) 1003-1013
    CrossrefPubMedGoogle Scholar
  • 37 Coker P, Lebkicher C, Harris L, Snape J. The effects of constraint-induced movement therapy for a child less than one year of age. NeuroRehabilitation 2009; 24 (03) 199-208
    CrossrefPubMedGoogle Scholar
  • 38 Basser PJ, Pajevic S, Pierpaoli C, Duda J, Aldroubi A. In vivo fiber tractography using DT-MRI data. Magn Reson Med 2000; 44 (04) 625-632
    CrossrefPubMedGoogle Scholar
  • 39 Bouza H, Rutherford M, Acolet D, Pennock JM, Dubowitz LM. Evolution of early hemiplegic signs in full-term infants with unilateral brain lesions in the neonatal period: a prospective study. Neuropediatrics 1994; 25 (04) 201-207
    Article in Thieme ConnectPubMedGoogle Scholar
  • 40 Eyre JA, Smith M, Dabydeen L. , et al. Is hemiplegic cerebral palsy equivalent to amblyopia of the corticospinal system?. Ann Neurol 2007; 62 (05) 493-503
    CrossrefPubMedGoogle Scholar