The effect of modified constraint-induced movement therapy in children with hemiparetic cerebral palsy. Consecutive or intermittent days?

Abstract

Purpose

To investigate effect of modified constraint-induced movement therapy (mCIMT) administered on consecutive or intermittent days on upper limb function in children with hemiparetic cerebral palsy (CP).

Materials and methods

Thirty-three children (age range 5–18 y) with hemiparetic CP separated into three groups: consecutive mCIMT group (n = 11), intermittent mCIMT group (n = 11), control group (n = 11). The outcome measures consist of Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS), Pediatric Balance Scale (PBS), Modified Tardieu Scale (MTS), Jebsen-Taylor Hand Function Test (JTHFT), Children's Hand Use Experience Questionnaire (CHEQ), Abilhand Kids Questionnaire, surface Electromyography (sEMG). The evaluations were made baseline, 10 days after, 5 weeks after the treatment.

Results

Improvements were achieved in all groups. The use of upper extremities in daily life activities (p < 0.01), speed of performing the activities (p < 0.001), grasping efficiency (p < 0.001), the amount of a decrease in the children's sense of discomfort while performing activities (p < 0.001) on the affected side in both mCIMT groups were better than the control group. The gain levels in mCIMT groups were similar (p > 0.05).

Conclusions

Administration of mCIMT on intermittent days facilitate the adaptation of a child, it was concluded to be a more tolerable method and could be more effective.

Implications for rehabilitation

• mCIMT is more effective than low-dose conventional therapeutic interventions in improving paretic upper limb functions in children with hemiparetic CP.

• The application of mCIMT in the child's natural environment increases the motivation to participate in the treatment.

• The application of mCIMT on intermittent days will be more easily tolerated in paediatric individuals and will increase participation in the treatment.

Keywords:

• Modified-constraint induced movement therapy
• hemiparetic cerebral palsy
• surface electromiyography
• upper extremity
• spasticity

Acknowledgements

Researchers would like to thank all participants for taking part in this study.

Disclosure statement

The authors have stated they had no interests that might be perceived as posing a conflict or bias.