Forced use as a home-based intervention in children with congenital hemiplegic cerebral palsy: Choosing the appropriate constraint

Abstract

Purpose. The purpose of this study was (1) to identify the most appropriate splint from children's and parents' perspective as reflected by effectiveness and adherence to home-based forced use therapy (FUT). (2) To provide guidance in the development of a practical and effective protocol based on forced use principles.

Method. A crossover design with a convenience sample of children with hemiplegic cerebral palsy and their parents was used to test three types of splint (mitt, short splint and long splint) during home-based FUT. Children wore the splints for a minimum of 1 h/ day during physical activity. Outcome measures included a daily log and a questionnaire (completed by parents), an actometer worn on the affected hand to quantify movement and video recordings to inform quality of movement.

Results. The short splint was found to be the most effective and acceptable restraining device. Wearing devices for more than 1 h per day was not considered acceptable by either parents or children.

Conclusion. A short splint, worn for 1 h per day was found to be the most acceptable protocol.

Keywords:

• Constraint-induced therapy
• cerebral palsy

Acknowledgements

This project was supported by the Greek State Scholarships Foundation (IKY). The authors thank all the volunteer paediatricians and therapists, who collaborated for the recruiting part of this study and the children and families who participated. They also thank Mr. Sotirios Karykas for his contribution as a rater.