Motor learning curve and long-term effectiveness of modified constraint-induced movement therapy in children with unilateral cerebral palsy: a randomized controlled trial. Modified Constraint-Induced Movement Therapy combined with Bimanual Training (mCIMT-BiT) in children with unilateral spastic cerebral palsy: how are improvements in arm-hand use established? Forced-use therapy for children with cerebral palsy in the community setting: a single-blinded randomized controlled pilot trial. Multisite Trial Comparing the Efficacy of Constraint-Induced Movement Therapy with that of Bimanual Intensive Training in Children with Hemiplegic Cerebral Palsy: Postintervention Results Best responders after intensive upper-limb training for children with unilateral cerebral palsy. An ecological approach of Constraint Induced Movement Therapy for 2-3-year-old children: a randomized control trial. Efficacy of modified constraint induced movement therapy in improving upper limb function in children with hemiplegic cerebral palsy: A randomized controlled trial Unimanual and Bimanual Intensive Training in Children With Hemiplegic Cerebral Palsy and Persistence in Time of Hand Function Improvement A modified constraint-induced movement therapy (CIT) program improves paretic arm use and function in children with cerebral palsy. Functional impact of constraint therapy and bimanual training in children with cerebral palsy: a randomized controlled trial. Adapted version of constraint-induced movement therapy promotes functioning in children with cerebral palsy: a randomized controlled trial The effect of intensive bimanual training on coordination of the hands in children with congenital hemiplegia. Effectiveness of Modified Constraint-Induced Movement Therapy in Children With Unilateral Spastic Cerebral Palsy: A Randomized Controlled Trial Bimanual Training and Constraint-Induced Movement Therapy in Children With Hemiplegic Cerebral Palsy Efficacy of constraint-induced movement therapy for children with cerebral palsy with asymmetric motor impairment. Efficacy of Constraint-Induced Therapy on Functional Performance and Health-Related Quality of Life for Children With Cerebral Palsy Modified constraint-induced therapy for children with hemiplegic cerebral palsy: a randomized trial. Effect of constraint-induced therapy on upper limb functions: A randomized control trial Modified constraint-induced movement therapy versus intensive bimanual training for children with hemiplegia – a randomized controlled trial Randomized trial of constraint-induced movement therapy and bimanual training on activity outcomes for children with congenital hemiplegia. Intensive Pediatric Constraint-Induced Therapy for Children With Cerebral Palsy: Randomized, Controlled, Crossover Trial Efficacy of Constraint-Induced Movement Therapy and Bimanual Training in Children with Hemiplegic Cerebral Palsy in an Educational Setting Efficacy of constraint-induced movement therapy and electrical stimulation on hand function of children with hemiplegic cerebral palsy: a controlled clinical trial Effects of modified constraint-induced movement therapy in virtual environment on upper-limb function in children with spastic hemiparetic cerebral palsy: a randomised controlled trial. Efficacy of forced-use therapy in hemiplegic cerebral palsy. Efficacy of a child-friendly form of constraint-induced movement therapy in hemiplegic cerebral palsy: a randomized control trial. Participation outcomes in a randomized trial of 2 models of upper-limb rehabilitation for children with congenital hemiplegia. Effect of therapist-based constraint-induced therapy at home on motor control, motor performance and daily function in children with cerebral palsy: a randomized controlled study Treatment of Congenital Hemiparesis With Pediatric Constraint-Induced Movement Therapy Equivalent Retention of Gains at 1 Year After Training With Constraint-Induced or Bimanual Therapy in Children With Unilateral Cerebral Palsy Implementation of constraint-induced movement therapy for young children with unilateral cerebral palsy in Jordan: a home-based model
The goal of this study was to determine the progression of manual dexterity during 6 weeks ( 54h ) ( modified ) constraint-induced movement therapy ( (m)CIMT ) followed by 2 weeks ( 18h ) bimanual training ( BiT ) in children with unilateral spastic cerebral palsy ( CP ) , to establish whether and when a maximal training effect was reached and which factors might influence the motor learning curve . In addition , long-term retention of effects was determined . In a r and omized controlled trial of 52 children with CP , aged 2.5 - 8 years , comparing mCIMT-BiT to conventional therapy  , 28 children were allocated to the mCIMT-BiT group . This group was assessed weekly with the Box and Block test . Long-term effectiveness was determined by collecting follow-up data of the primary ( Assisting H and Assessment , ABILH AND -Kids ) and secondary ( Melbourne , COPM ) outcomes at six months and one year after intervention . Fifteen children ( 53.6 % ) reached a maximum training effect within the mCIMT period . This group differed from others with respect to age , but not gender , affected side or manual ability . Children younger than five years had a greater chance to reach a maximum score within 6 weeks mCIMT ( OR=6.67 , 95%CI=1.24 - 35.71 ) that stabilized already after four weeks ; older children showed a longer progression and tended to decline afterwards . In both age groups , beneficial effects were retained in the long term . The findings suggest that children of 5 years and older might profit from a longer period of mCIMT than 54h to reach their maximum unimanual capacity and to retain this capacity during subsequent bimanual training A recent r and omized controlled trial indicated that modified Constraint-Induced Movement Therapy followed by Bimanual Training ( mCIMT-BiT ) is an effective intervention to improve spontaneous use of the affected upper limb in children with unilateral spastic cerebral palsy ( CP ) . The present study aim ed to investigate how the above-mentioned improvements as a result of 8 weeks mCIMT-BiT were established . 52 children with unilateral spastic CP with Manual Ability Classification System ( MACS ) scores I , II or III and aged 2.5 - 8 years were r and omly allocated to either mCIMT-BiT ( n = 28 ) or Usual Care ( UC ) ( n = 24 ) . Developmental disregard ( ' learned non-use ' ) and upper limb capacity and performance scores were derived from the Video Observations Aarts and Aarts , module Determine Developmental Disregard . Active and passive range of motion at the affected wrist and elbow were assessed using goniometry during isolated movements . Upper limb capacity and performance demonstrated significantly greater improvements after mCIMT-BiT compared to UC , which lasted up to 8 weeks follow-up , whereas developmental disregard and passive and active range of motion did not show differential effects . The results support the notion that improvement of capacity and performance of the upper limb through mCIMT-BiT in children with unilateral spastic CP is based on a better utilization of existing motor functions of the affected arm and h and . However , enhancement of the overall amount of use ( or the reduction of learned non-use ) may still be suboptimal leaving room for improvement of this treatment OBJECTIVE The aim of this study was to eluci date the feasibility , efficacy , and sustainability of a home-based , two-week , forced-use therapy ( FUT ) program for children with hemiplegic cerebral palsy ( CP ) . METHODS A single-blinded , r and omized controlled design was chosen . The Melbourne Assessment of Unilateral Upper Limb Function ( MA ) was carried out at baseline , pretest , post-test , and follow-up at two weeks , three months , and 12 months . Additionally , a question naire was used to evaluate the clinical relevance and integration of FUT in the home setting . 23 children , ages six to 16 years , took part in the study and were r and omized into either an intervention group ( n=12 , mean age 9.8 ± 3.5 years ) or a control group ( $ n=$ 11 , mean age 11.7 ± 3.7 years ) . The intervention consisted of constraint of the unaffected h and for six hours per day and promotion of different activities of daily living according to an age-related manual for the use of the non-constraint h and . RESULTS Unpaired t-tests for the change in MA scores relative to the pre-test values showed no difference between the groups at any time point : post-test ( p=0.304 ) , two weeks ( p=0.193 ) , or three months ( p=0.957 ) . Improvements in Activities of Daily Living ( ADLs ) assessed by question naires were observed by 64 % of parents of the intervention group . Fifty-five percent of parents stated that the FUT program was exhausting and only 45 % indicated that they achieved constraint for 6 hours per day . CONCLUSION Our results evaluating a home-based FUT program of 14 days show no statistically significant improvement of upper extremity function in children with CP . The lack of compliance and absence of structured exercises proved to be considerable pitfalls of the home-based FUT program . Therefore , future home based FUT concepts should put special emphasis on the close monitoring and support of children and their families , as well as the integration of structured exercise sessions Objective : The aim of this study was to compare the effects of modified constraint-induced movement therapy ( mCIMT ; restraint of unaffected limb combined with unimanual intensive rehabilitation ) with those of a bimanual intensive rehabilitation treatment ( IRP ) in children with hemiplegic cerebral palsy after a 10-wk practice vs.  st and ard treatment ( ST ) . Design : This study is a multicenter , cluster-r and omized controlled clinical trial of tested groups of children with hemiplegic cerebral palsy treated using mCIMT , IRP , or ST . For 10 wks , in mCIMT and IRP , the intensive practice lasted 3 hrs/day , 7 days/wk ; in ST , 1-hr sessions twice a week were provided . The primary outcomes are upper limb/h and function ( Quality of Upper Extremity Skills Test ) and activities of daily living ( Besta Scale ) , which are assessed before and after treatment . One hundred five patients were recruited , 39 to the mCIMT group , 33 to the IRP group , and 33 to the ST group . Results : IRP and mCIMT significantly improved paretic h and function both in the Quality of Upper Extremity Skills Test and in the Besta Scale , whereas ST did not . mCIMT improved grasp more than IRP did ( P < 0.01 ) , whereas bimanual spontaneous use in play increased more with IRP ( P = 0.0005 ) . Activities of daily living in 2- to 6-yr-olds improved more with IRP ( P < 0.0001 ) than with mCIMT ( P = 0.011 ) . Unaffected limb improved more from bimanual practice ( IRP ; P = 0.02 ) . Conclusions : More advantages result ed from intensive practice than in the st and ard one , in mCIMT for grasp and in IRP for bimanual spontaneous use and activities of daily living in younger children OBJECTIVE To delineate characteristics of best responders in a r and omized trial comparing constraint-induced movement therapy ( CIMT ) to bimanual training for children with unilateral cerebral palsy . DESIGN Secondary analysis of a single-blind matched-pairs r and omized comparison trial . SETTING Community sporting facilities in 2 Australian capital cities . PARTICIPANTS Children ( n=64 ; mean age , 10.2±2.7y ; 52 % boys ) , matched for age , sex , side of hemiplegia , and upper-limb function , were r and omized within pairs to CIMT or bimanual training .  Sixty-one children who completed CIMT ( n=31 ) or bimanual training ( n=30 ) were included in this study . INTERVENTIONS Each intervention was delivered in day camps ( total 60h over 10d ) using a novel circus theme with goal -directed training . MAIN OUTCOME MEASURES Change between baseline , 3 , and 26 weeks on the Melbourne Assessment of Unilateral Upper Limb Function ( MUUL>7.4 % ) , Assisting H and Assessment ( AHA>4 raw score points ) , and Canadian Occupational Performance Measure ( COPM>2 points ) defined best responders . RESULTS Poorer baseline h and function predicted a best response for unimanual capacity of the impaired upper limb ( MUUL ) immediately postintervention ; however , at 26 weeks the odds of achieving a favorable outcome were 21 times greater for CIMT than bimanual training . A favorable response for bimanual performance ( AHA ) was predicted by immediate change in Jebsen-Taylor h and function test scores . Age ( older ) , left-sided hemiplegia , and lower-baseline COPM performance scores significantly predicted favorable individualized outcomes . CONCLUSIONS Secondary analysis of a r and omized trial directly comparing 2 upper-limb training models , found children with poorer h and function benefited most . Favorable outcomes for bimanual performance were associated with gains in movement efficiency and older children with left-sided hemiplegia achieved more favorable gains in perceived occupational performance UNLABELLED The aim was to evaluate the effect of Eco-CIMT in young children with unilateral cerebral palsy in a r and omized controlled crossover design . The training was implemented within the regular pediatric services , provided by the child 's parents and /or preschool teacher and supervised by the child 's regular therapist . METHODS Twenty-five children ( mean age 28.8 months [ SD 11.2 ] , 72 % male ) participated .  Assisting H and Assessment ( AHA ) was used as the outcome measure . The Eco-CIMT was provided for 2h a day over a period of two months . Children were r and omized into two groups and started either with Eco-CIMT or as controls with a four-month washout period before crossing over . RESULT A significant effect of Eco-CIMT  was found when compared to the control period , and the estimated treatment effect was 5.47 ( 95 % C.I. 2.93 - 8.02 ) ( including both Group 1 and Group 2 ) ( p < 0.001 ) . The non-significant estimated carryover effect allowed us to collapse the two groups based on estimates from the ANOVA model . No clear relationship to hours of training , age or general attitudes of mastery was found . CONCLUSION Eco-CIMT influenced development more than ordinary treatment at this age when Eco-CIMT was performed by parents and preschool teachers supervised by the child 's ordinary therapist PURPOSE The objective of this r and omized single blind ( outcome assessor ) controlled trial was to evaluate the efficacy of 4 weeks of modified constraint induced movement therapy ( mCIMT ) in improving upper limb function in 3 - 8 years old children with hemiplegic cerebral palsy . METHODS Thirty-one children were r and omly assigned to receive the mCIMT ( N=16 ) with conventional therapy or conventional therapy alone ( N=15 ) . Children were evaluated three times ( at enrollment , follow up at 4 weeks and 12 weeks ) . The primary outcome measure was difference in " change in mean total QUEST scores " at 4 weeks of intervention between the intervention and the control arm . RESULTS After 4 weeks of intervention , mCIMT group showed significant change in the affected upper limb in QUEST scores ( 10.7 ± 5.2 vs 1.4 ± 1.7 , p<0.001 ) and time ( s ) to complete nine-hole-pegboard test compared with control group [ 60(0 - 130 ) vs 5(-12 to 30 ) , p<0.001 ] . The improvement observed in upper limb function after 4 weeks of intervention persisted 8 weeks after discontinuation of intervention in mCIMT group . CONCLUSION The modified constraint induced movement therapy appears to be effective in improving upper limb function in 3 - 8 years old hemiplegic cerebral palsy children This study aims to compare in hemiplegic children the effectiveness of intensive training ( unimanual and bimanual ) versus st and ard treatment in improving h and function , assessing the persistence after 6 months . A multicenter , prospect i ve , cluster-r and omized controlled clinical trial was design ed comparing 2 groups of children with hemiplegic cerebral palsy , treated for 10 weeks ( 3 h/d 7 d/wk ; first with unimanual constraint-induced movement therapy  , second with intensive bimanual training ) with a st and ard treatment group . Children were assessed before and after treatment and at 3 and 6 months postintervention using Quality of Upper Extremity Skills Test ( QUEST ) and Besta Scales .  One hundred five children were recruited ( 39 constraint-induced movement therapy , 33 intensive bimanual training , 33 st and ard treatment )  . Constraint-induced movement therapy and intensive bimanual training groups had significantly improved h and function , showing constant increase in time . Grasp improved immediately and significantly with constraint-induced movement therapy , and with bimanual training grasp improved gradually , reaching the same result . In both , spontaneous h and use increased in long-term assessment AIM Constraint-induced movement therapy ( CIT ) is a rehabilitation intervention put forward by Taub and colleagues for sensorimotor disorders in children with hemiparesis , comprising consisting of the restraint of the unaffected arm and concurrent intensive training of the affected arm for six hours/day for two weeks . The aim of this study was to evaluate the effectiveness of a modified CIT program ( mCIT ) characterized by restraining the unaffected h and with a cotton mitten during daily activities and a reduced intensity training program for two h/week for five weeks . METHODS Ten children ( age : 1 - 9 years ) with hemiparetic cerebral palsy were enrolled in a r and omized , cross-over study in which the effects of a mCIT and a conventional physiotherapy program were compared . The amount of use and the functional performance of the affected arm were evaluated by means of two specifically devised tests ( Use and Function Test ) . A further test evaluated functional performance during bimanual tasks . These measures showed a good inter-rater and inter-session reliability . All tests were administered before , at the end and four weeks after treatment . RESULTS Significant differences between the two therapeutic approaches were evidence d in both affected arm use ( P=0.008 ) and function ( P=0.018 ) . These improvements maintained at the follow-up ( Use Test P=0.07 ; paretic arm function P=0.012 ) . Bimanual function performance showed a trend towards improvement in both post-treatment and follow-up testing . The conventional physiotherapy group did not show any improvement in any outcome measure . CONCLUSIONS The mCIT program proposed in the present study showed to be a promising rehabilitative procedure in children with congenital arm paresis after cerebral palsy OBJECTIVE We compared children 's self-care performance and caregivers ' perception of children 's performance on functional goals established for children with hemiplegic cerebral palsy ( CP ) after unimanual constraint-induced movement therapy ( CIMT ) or h and -arm bimanual intensive training ( HABIT ) . METHOD Sixteen children with CP were r and omized to the CIMT or HABIT group . Interventions lasted for 15 days , 6 hr/day , totaling 90 hr . We used the Pediatric Evaluation of Disability Inventory and the Canadian Occupational Performance Measure ( COPM ) to assess the children 's daily functioning and mixed analyses of variance to compare group means on functional test scores before and after intervention . RESULTS Both groups showed significant improvements on functional measures . Group × Assessment interaction in COPM performance revealed greater improvements for the HABIT group after intervention ( p = .04 ) . CONCLUSION The results suggest that specificity of training exists only for performance of specific goals established by parents and that both CIMT and HABIT can be used to increase children 's daily functioning Objective : To evaluate the effects of constraint-induced movement therapy on the use of the affected arm and on daily functioning in children with hemiplegic cerebral palsy . Design : A single-blinded r and omized clinical trial . Subjects : Sixteen children with cerebral palsy r and omized to intervention ( n = 8 , 4 males , 4 females , mean age 5 years and 6 months ) and control groups ( n = 8 , 4 males , 4 females , mean age 6 years and 7 months ) . Interventions : Non-affected arm of intervention group was restricted for 10 hours/ day and the affected arm intensively trained for 3 hours/day for two weeks . The intervention protocol included one week of bimanual functional training following constraint therapy . The control group maintained usual rehabilitation throughout the intervention period . Main measures : Pediatric Evaluation of Disability Inventory ( self-care domain ) and an adapted version of the Jebsen — Taylor test were administered before and after intervention , and at one month follow-up . General linear models tested differences in gain scores and the number needed to treat estimated relative effectiveness of intervention protocol for functional skills and independence in self-care . Results : Results are reported for 15 children who completed assessment s and intervention . Higher gains were observed in the intervention group for functional skills and independence post intervention ( dfunctional skills = 1.61 , P = 0.0134 ; dindependence=1.37 ; P = 0.0001 ) and follow-up ( dfunctional skills = 2.08 , P = 0.004 ; dindependence = 0.85 ; P = 0.0016 ) . No group difference in manual dexterity gains was observed . Low indices of number needed to treat ( 1.75 and 2.33 ) illustrate clinical relevance of intervention . Conclusions : The protocol associating constraint-induced movement therapy and bimanual functional training was effective in promoting daily living functioning among children with cerebral palsy Recent studies have suggested efficacy of intensive bimanual training in improving the quality and quantity of affected h and use in children with hemiplegia . However , it is not known whether such training affects the coordination of the two h and s. In the present study , 20 children with congenital hemiplegia ( age 4 - 10 years ; MACS levels I-II ) were r and omly assigned to either an intensive bimanual training ( H and -Arm Bimanual Intensive Therapy : HABIT ) group , or a control group consisting of equally intensive unimanual treatment ( Constraint-Induced Movement Therapy , CIMT ) for 6h per day for 15 days ( 90h ) . To assess their bimanual coordination , children were asked to open a drawer with one h and and manipulate its contents with the other h and . 3-D movement kinematics were recorded and subsequently analyzed by a blind evaluator . The role of the two h and s was varied . Following treatment , superior improvement in bimanual coordination was found for the bimanual training group as indicated by greater movement overlap ( the percentage of time with both h and s engaged in the task p = 0.047 ) and better goal synchronization ( reduced time differences between the two h and s completing the task goals , p = 0.005 ) . The results suggest that bimanual training improves the spatial-temporal control of the two h and s , and are in agreement with the principle of practice specificity Background . In children with unilateral spastic cerebral palsy ( CP ) , there is only limited evidence for the effectiveness of modified constraint-induced movement therapy ( mCIMT ) . Objective . To investigate whether 6 weeks of mCIMT followed by 2 weeks of bimanual task-specific training ( mCIMT-BiT ) in children with unilateral spastic CP improves the spontaneous use of the affected limb in both qualitative and quantitative terms more than usual care ( UC ) of the same duration . Methods . Children with unilateral spastic CP with Manual Ability Classification System ( MACS ) scores I , II , or III and aged 2.5 to 8 years were recruited and r and omly allocated to either the mCIMT-BiT group ( three 3-hour sessions per week : 6 weeks of mCIMT , followed by 2 weeks of task-specific training in goal -directed bimanual play and self-care activities ) or to 1.5 hours of more general physical or occupational weekly plus encouragement to use the affected h and for the UC group . Primary outcome measures were the Assisting H and Assessment and the ABILH AND -Kids . Secondary outcomes were the Melbourne Assessment of Unilateral Upper Limb Function , the Canadian Occupational Performance Measure , and the Goal Attainment Scale . Results . Twenty-eight children were allocated to  mCIMT-BiT  and 24 to UC . Except for the Melbourne , all primary and secondary outcome measures demonstrated significant improvements in the mCIMT-BiT group . Conclusion . mCIMT followed by task-specific training of goal -directed bimanual play and self-care activities is an effective intervention to improve the spontaneous use of the more affected upper limb in children with relatively good baseline upper extremity function Background . Constraint-induced movement therapy ( CIMT ) promotes h and function using intensive unimanual practice along with restraint of the less-affected h and . CIMT has not been compared with a treatment with equivalent dosing frequency and intensity in children with cerebral palsy ( CP ) . Objectives . The authors report a r and omized trial comparing CIMT and a bimanual intervention ( h and -arm intensive bimanual therapy ; HABIT ) that maintains the intensity of practice associated with CIMT but where children are engaged in functional bimanual tasks . Methods . A total of 42 participants with hemiplegic CP between the ages of 3.5 and 10 years ( matched for age and h and function ) were r and omized to receive 90 hours of CIMT or an equivalent dosage of functional bimanual training ( HABIT ) conducted in day-camp environments . A physical therapist blinded to treatment allocation tested h and function before and after treatment . The primary outcomes were changes in Jebsen-Taylor Test of H and Function ( JTTHF ) and Assisting H and Assessment ( AHA ) scores . Secondary measures included the Goal Attainment Scale ( GAS ) . Results . Both the CIMT and HABIT groups demonstrated comparable improvement from the pretest to immediate posttest in the JTTHF and AHA ( P < .0001 ) , which were maintained at 6 months . GAS , however , revealed greater progress toward goals for the HABIT group ( P < .0001 ) , with continued improvement across test sessions for both groups ( P < .0001 ) . Conclusions . Both CIMT and bimanual training lead to similar improvements in h and function . A potential benefit of bimanual training is that participants may improve more on self-determined goals OBJECTIVE Constraint-Induced Movement ( CI ) therapy has been found to be a promising treatment for substantially increasing the use of extremities affected by such neurologic injuries as stroke and traumatic brain injury in adults . The purpose of this study was to determine the applicability of this intervention to young children with cerebral palsy . METHODS A r and omized , controlled clinical trial of pediatric CI therapy in which 18 children with diagnosed hemiparesis associated with cerebral palsy ( 7 - 96 months old ) were r and omly assigned to receive either pediatric CI therapy or conventional treatment . Pediatric CI therapy involved promoting increased use of the more-affected arm and h and by intensive training ( using shaping ) of the more-impaired upper extremity for 6 hours/day for 21 consecutive days coupled with bivalved casting of the child 's less-affected upper extremity for that period . Children 's functional upper-extremity skills were assessed in the laboratory ( blinded scoring ) and at home ( parent ratings ) just prior , after , and 3 weeks posttreatment . Treated children were followed for 6 months . RESULTS Children receiving pediatric CI therapy compared with controls acquired significantly more new classes of motoric skills ( 9.3 vs 2.2 ) ; demonstrated significant gains in the mean amount ( 2.1 vs 0.1 ) and quality ( 1.7 vs 0.3 ) of more-affected arm use at home ; and in a laboratory motor function test displayed substantial improvement including increases in unprompted use of the more-affected upper extremity ( 52.1 % vs 2.1 % of items ) . Benefits were maintained over 6 months , with supplemental evidence of quality -of-life changes for many children . CONCLUSION Pediatric CI therapy produced major and sustained improvement in motoric function in the young children with hemiparesis in the study To better generalize training effects to the context of daily living , home-based constraint-induced therapy has been proposed . Therapeutic success of constraint-induced therapy is limited as to whether the improvements in functional performance can be transferred to quality of life . This r and omized controlled trial aim ed to investigate the efficacy of home-based constraint-induced therapy on functional performance and health-related quality of life .  Twenty-two children with spastic unilateral cerebral palsy ( 6 - 8 years , 10 boys ) were r and omly assigned to receive constraint-induced therapy or traditional rehabilitation . Home-based constraint-induced therapy had immediate and maintaining effects on motor efficacy and functional performance and induced greater gains in health-related quality of life in the long run than in the short term . The home-based constraint-induced therapy protocol ( relatively moderate intensity and shortened constraint time ) , which might balance the effectiveness and compliance of participants and caregivers , may be an effective alternative to conventional constraint-induced therapy AIM Conventional constraint-based therapies are intensive and dem and ing to implement , particularly for children . Modified forms of constraint-based therapies that are family-centred may be more acceptable and feasible for families of children with cerebral palsy (CP)-but require rigorous evaluation using r and omized trials . The aim of this study was to determine the effects of modified constraint-induced therapy compared with intensive occupational therapy on activities of daily living and upper limb outcomes in children with hemiplegic CP . METHOD In this assessor-blinded pragmatic r and omized trial , 50 children ( 27 males , 23 females ; age range 19 mo-7 y 10 mo ) with hemiplegic CP were r and omized using a concealed allocation procedure to one of two 8-week interventions : intensive occupational therapy ( n = 25 ) , or modified constraint-induced therapy ( n = 25 ) . Manual Ability Classification System ( MACS ) levels of the participants were , level I n = 2 , II n = 37 , III n = 8 , and level IV n = 1 ; Gross Motor Function Classification System ( GMFCS ) levels were , level I n = 33 , level II n = 15 , and level III n = 1 . Participants were recruited through three specialist CP centres in Australia and r and omized between January 2008 and April 2010 . Children r and omized to modified constraint-induced therapy wore a mitt on the unaffected h and for 2 hours each day , during which time the children participated in targeted therapy . The primary outcome was the Canadian Occupational Performance Measure ( COPM -- measured on a 10-point scale ) at completion of therapy . Other outcome measures were Goal Attainment Scaling , Assisting H and Assessment , Pediatric Motor Activity Log , Modified Ashworth Scale , Modified Tardieu Scale , and a parent question naire . Assessment s were carried out at 10 weeks and 6 months following r and omization . RESULTS All participants were included in the analysis . Between-group differences for all outcomes were neither clinical ly important nor statistically significant . The mean difference in COPM was 0.3 ( 95 % confidence interval [ CI ] -0.8 to 1.4 ; p=0.61 ) and mean difference in COPM satisfaction was 0.1 ( 95 % CI -1.1 to 1.2 ; p=0.90 ) . Minor adverse events were reported by five of the 25 participants in the modified constraint-induced therapy group and by one of the 25 in the intensive occupational therapy group . All adverse events were related to participants ' lack of acceptance of therapy . INTERPRETATION Modified constraint-induced therapy is no more effective than intensive occupational therapy for improving completion of activities of daily living or upper limb function in children with hemiplegic CP Abstract Aims : Children with congenital hemiparesis have unilateral upper extremity involvement , limiting their ability in unilateral or bilateral manual tasks , thus negatively influencing their participation in daily activities . Constraint-induced movement therapy ( CIMT ) has been shown to be promising for improving upper-limb functions in children with cerebral palsy . Clinical assessment s may be needed to quantify and qualify changes in children 's performance following its application . Methods : This study investigated the effectiveness of a child-friendly form of CIMT to improve upper extremity functional performance .  Thirty congenitally hemiparetic children aged 4–8 years were r and omly assigned to receive either a CIMT program ( study group ) or a conventional non-structured therapy program ( control group ) . The programs were applied for both groups for six hours daily , five days weekly for four successive weeks . The Pediatric Arm Function Test , Quality of Upper Extremity Skills Test , and isokinetic muscular performances of shoulder flexors , extensors , and abductors expressed as peak torque were used to evaluate immediate and long-lasting efficacy of CIMT . Results : The results showed improvement in the involved upper extremity performances in different evaluated tasks immediately post-CIMT program application compared with the control group . These improvements continued three months later . Conclusion : Pediatric CIMT with shaping produced considerable and sustained improvement in the involved upper extremity movements and functions in children with congenital hemiparesis Objective : To clarify whether modified constraint-induced movement therapy provides greater improvement than intensive bimanual training both for motor functions and spontaneous use of the paretic arm and h and in everyday life activities . Design : R and omized controlled , single-blind trial . Setting : Inpatient paediatric rehabilitation clinic . Subjects : Forty-seven children with unilateral cerebral palsy or other non-progressive hemiplegia ( aged 3.3–11.4 years ) were r and omly assigned to either a modified constraint-induced movement programme ( kid-CIMT ) or intensive bimanual training . Interventions : Patients in the kid-CIMT group received 60 hours of unilateral constraint-induced and 20 hours of bimanual training over four weeks . Patients in the bimanual treatment group received 80 hours of bimanual training over four weeks . Main outcome measures : Melbourne Assessment of Unilateral Upper Limb Function and Assisting H and Assessment . Results : Modified constraint-induced therapy provided a significantly better outcome for isolated motor functions of the paretic arm than bimanual training ( gain in Melbourne Assessment , percent score : 6.6 vs. 2.3 , P= 0.033 ) . Regarding spontaneous use both methods led to similar improvement ( gain in Assisting H and Assessment , percent score : 6.2 vs. 4.6 , P= 0.579 ) . More-disabled children showed greater improvement than less-disabled ones ( correlation with Assisting H and Assessment pretreatment score r = −0.40 ) . Age did not affect treatment outcome . Conclusions : Modified constraint-induced movement therapy can improve isolated functions of the hemiplegic arm better than intensive bimanual training , but regarding spontaneous h and use in everyday life both methods lead to similar improvement . Improvements are generally greater in more impaired children . Age does not affect outcome AIM To determine if constraint-induced movement therapy ( CIMT ) is more effective than bimanual training ( BIM ) in improving upper limb activity outcomes for children with congenital hemiplegia in a matched-pairs r and omized trial . METHOD Sixty-three children ( mean age 10.2 , SD 2.7 , range 5 - 16 y ; 33 males , 30 females ) , 16 in Manual Ability Classification System level I , 46 level II , and 1 level III and 16 in Gross Motor Function Classification level I , 47 level II ) were r and omly allocated to either CIMT or BIM group day camps ( 60 hours over 10 days ) . The Melbourne Assessment of Unilateral Upper Limb Function assessed unimanual capacity of the impaired limb and Assisting H and Assessment evaluated bimanual coordination at baseline , 3 and 26 weeks , scored by blinded raters . RESULTS After concealed r and om allocation , there was no baseline difference between groups .  CIMT had superior outcomes compared with BIM for unimanual capacity at 26 weeks ( estimated mean difference [ EMD ] 4.4 , 95 % confidence interval [ CI ] 2.2 - 6.7 ; p < 0.001 ) . There was no other significant difference between groups post-intervention . Both groups demonstrated significant improvements in bimanual performance at 3 weeks , with gains maintained by BIM at 26 weeks ( EMD 2.3 ; 95 % CI 0.6 - 4.0 ; p = 0.008 ) . Interpretation Overall , there were only small differences between the two training approaches . CIMT yielded greater changes in unimanual capacity of the impaired upper limb compared with BIM . Results generally reflect specificity of practice , with CIMT  improving unimanual capacity and BIM improving bimanual performance . Considerable inter-individual variation in response to either intervention was evident . Future research should consider serial sequencing unimanual then BIM approaches to optimize upper limb outcomes for children with congenital hemiplegia A r and omized crossover trial of a new form of pediatric rehabilitation was conducted with 18 children with hemiparesis . Half were r and omly assigned to receive pediatric constraint-induced therapy involving constraint of the functional upper extremity and intensive therapy with the hemiparetic upper extremity . Controls received conventional physical and occupational therapy and then were crossed over to receive pediatric constraint-induced therapy . Pediatric constraint-induced therapy produced significantly greater gains than conventional rehabilitation services . ( J Child Neurol 2006;21:931—938 ; DOI 10.2310/7010.2006.00201 ) ABSTRACT We examined the efficacy of modified constraint-induced movement therapy ( CIMT ) and h and -arm bimanual intensive therapy ( HABIT ) in a special education preschool/kindergarten in Israel . Twelve children ( 1.5–7 years ) with congenital hemiplegic cerebral palsy were r and omized to receive modified CIMT ( n = 6 ) or HABIT ( n = 6 ) . Occupational and physical therapists administered usual and customary care for 8 weeks ; children then crossed over to receive CIMT or HABIT 2 hr/day , 6 days/week for 8 weeks from their occupational therapist . The Assisting H and Assessment and Quality of Upper Extremity Skills Test were administered 2 months prior to the intervention , immediately before , immediately after intervention , and 6 months after the first baseline assessment . Both groups demonstrated no change during baseline and comparable improvement following CIMT and HABIT ( p < .001 ) , which was maintained at 6-month follow-up . Results suggest that modified CIMT and HABIT provided in school-based setting s can lead to improvements in quality of bimanual skill and movement patterns Purpose : The purpose of this study is to compare the efficacy of constraint therapy , constraint therapy plus electrical stimulation , and occupational therapy in the treatment of h and dysfunction . Methods : Sixty-eight children with hemiplegic cerebral palsy were r and omly allocated to constraint therapy , constraint therapy plus electrical stimulation , and occupational therapy group . Three groups received 2 weeks of treatment . All participants were measured at baseline and 2 weeks , 3 and 6 months after treatment using measures of active ROM , grip strength , nine-peg hole test , upper extremity functional test , Peabody developmental motor scales ( PDMS ) , globe rating scale , and social life ability scale . Results : Three groups improved significantly ( p < 0.05 ) . The mean improvements between baseline and the end of follow-up were respectively 12.4 , 11.4 and 11.3 degrees for active ROM ; 12.8 , 10.5 and 8.8 mmHg for grip strength ; −22.3 , −30.7 and −14.0 s for nine-peg hole test ; 15.3 , 10.3 and 10.4 for upper extremity functional test scores ; 2.2 , 1.8 and 1.8 for grasping scores of PDMS ; 5.8 , 3.7 and 2.8 for visual-motor integration scores of PDMS ; 2.0 , 2.5 and 0.9 for globe rating scale scores ; 7.7 , 5.7 and 5.3 for social life ability scale scores  in constraint therapy plus electrical stimulation , constraint therapy , and occupational therapy group . The constraint therapy plus electrical stimulation group showed greater rate of improvement in upper extremity functional test scores ( p < 0.05 ) and visual-motor integration scores of PDMS ( p < 0.05 ) than the other two groups after treatment for 6 months . Conclusions : Constraint therapy plus electrical stimulation is likely to be best in improving h and performance in children with hemiplegic cerebral palsy . Implication s for Rehabilitation Children with hemiplegic cerebral palsy have major h and dysfunction problems that not only restrict activity and participation but also lead to secondary impairment . Constraint therapy , constraint therapy plus electrical stimulation and occupational therapy , is the technique available to these children . However , strong evidence for efficacy of the three interventions is still lacking . This study shows that all the three interventions improve h and performance and perceived changes . However , constraint therapy plus electrical stimulation is the most effective . Use of constraint therapy is advantageous in improving involved h and function and perceived changes OBJECTIVE To determine effects of implementing a practice period of modified constraint-induced movement therapy in a virtual environment on upper limb function in children with spastic hemiparetic cerebral palsy . METHODS In a single-blinded , r and omised , controlled trial , 32 participants ( 18 female , 14 male ) received 18 hours training in 3 different groups ( virtual reality , modified constraint-induced movement therapy , and a combination group ) . The fourth group was a control group . Training sessions occurred every other day , 3 times per week for 4-week . Each session lasted for 1.5 hours . Assessment sessions were conducted before , after , and 3-month after treatment period using pediatric motor activity log and the speed and dexterity subtest of the bruininks-oseretsky test of motor proficiency . Data analysis was conducted by ANOVA with repeated measures using SPSS 16.0 with alpha levels set at P < 0.05 . RESULTS Significantly higher gains were observed in the combination therapy group for the amount of limb use ( mean change , 2.72 ) , quality of movement ( mean change , 2.79 ) , and speed and dexterity ( mean change , 1.74 ) at post-test . These gains were maintained at the 3-month follow-up assessment . CONCLUSIONS Modified constraint-induced movement therapy in a virtual environment could be a promising rehabilitation procedure to enhance the benefits of both virtual reality and constraint-induced therapy techniques OBJECTIVE To determine the efficacy of forced-use therapy ( FUT ) on the improvement of upper-extremity function in children with hemiplegic cerebral palsy ( CP ) . DESIGN Prospect i ve case series . SETTING Outpatient ambulatory clinic in South Korea . PARTICIPANTS Thirty-one patients with hemiplegic CP were assigned to the FUT group ( n=18 ) or to the control group ( n=13 ) . The mean age of the patients in the FUT group was 33.2 months and in the control group it was 43.2 months . INTERVENTIONS The FUT group wore a short-arm Scotchcast on the unaffected arm for 6 weeks and also participated in a conventional rehabilitation program that included stretching exercises and functional occupational therapy for the upper extremity . The control group underwent the conventional rehabilitation program only . MAIN OUTCOME MEASURE H and function tests , including the box and block test ( BBT ) , Erhardt Developmental Prehension Assessment ( EDPA ) , and WeeFIM instrument taken before and after 6 weeks of treatment . RESULTS Before treatment , there was no significant difference between groups in the BBT , EDPA , and WeeFIM scores . After 6 weeks of treatment , however , the FUT group showed significant improvement in the affected arm in the BBT and EDPA scores , compared with the control group ( P<.05 ) . The self-care score on the WeeFIM was also significantly improved in the FUT group ( P<.05 ) . CONCLUSIONS FUT combined with a conventional rehabilitation program appears to be more effective than a rehabilitation program alone in improving affected h and function in children with hemiplegic CP Constraint-induced ( CI ) movement therapy is a promising therapy for improving upper limb function in adults after stroke . It involves restraint of the non-involved limb and extensive movement practice with the involved limb . In this study , a single-blinded , r and omized , control study was performed to examine the efficacy of CI therapy , modified to be child friendly , in children with hemiplegic cerebral palsy ( CP ) . Twenty-two children ( 8 females , 14 males ; mean age 6 y 8 mo [ SD 1 y 4 mo ] ; range 4 - 8 y ) were r and omized to either an intervention group ( n=11 ) or a delayed treatment control group ( n=11 ) . Children wore a sling on their non-involved upper limb for 6 hours per day for 10 out of 12 consecutive days and were engaged in play and functional activities . Children in the treatment group demonstrated improved movement efficiency and dexterity of the involved upper extremity , which were sustained through the 6-month evaluation period , as measured by the Jebsen-Taylor Test of H and Function and fine motor-subtests of the Bruininks-Oseretsky Test of Motor Proficiency ( p<0.05 in both cases ) . Initial severity of h and impairment and testing compliance were strong predictors of improvement . Caregivers reported significant increases in involved limb frequency of use and quality of movement . However , there was no change in strength , sensibility , or muscle tone ( p>0.05 in all cases ) . Results suggest that for a carefully selected subgroup of children with hemiplegic CP , CI therapy modified to be child-friendly , appears to be efficacious in improving movement efficiency of the involved upper extremity OBJECTIVE To determine if constraint-induced movement therapy ( CIMT ) is more effective than bimanual training to improve occupational performance and participation in children with congenital hemiplegia . DESIGN Single-blind r and omized comparison trial with evaluations at baseline , 3 , and 26 weeks . SETTING Community facilities in 2 Australian states . PARTICIPANTS Referred sample of children ( N=64 ; mean age ± SD , 10.2±2.7y , 52 % boys ) were matched for age , sex , side of hemiplegia , and upper-limb function and were r and omized to CIMT or bimanual training . After r and om allocation , 100 % of CIMT and 94 % of the bimanual training group completed the intervention . INTERVENTIONS Each intervention was delivered in day camps ( total 60 h over 10d ) using a circus theme with goal -directed training . Children receiving CIMT  wore a tailor-made glove during the camp . MAIN OUTCOME MEASURES The primary outcome was the Canadian Occupational Performance Measure ( COPM ) . Secondary measures included the Assessment of Life Habits ( LIFE-H ) , Children 's Assessment of Participation and Enjoyment , and School Function Assessment . RESULTS There were no between-group differences at baseline . Both groups made significant changes for COPM performance at 3 weeks ( estimated mean difference = 2.9 ; 95 % confidence interval [ CI ] , 2.3 - 3.6 ; P<.001 for CIMT ; estimated mean difference=2.8 ; 95 % CI , 2.2 - 3.4 ; P<.001 for bimanual training ) that were maintained at 26 weeks . Significant gains were made in the personal care LIFE-H domain  following CIMT ( estimated mean difference=0.5 ; 95 % CI , 0.1 - 0.9 ; P=.01 ) and bimanual training ( estimated mean difference=0.6 ; 95 % CI , 0.2 - 1.1 ; P=.006 ) . CONCLUSIONS There were minimal differences between the 2 training approaches . Goal -directed , activity-based , upper-limb training , addressed through either CIMT or bimanual training achieved gains in occupational performance . Changes in participation on specific domains of participation assessment s appear to correspond with identified goals Objective : To determine the effect of therapist-based constraint-induced therapy at home on motor performance , daily function and reaching control for children with cerebral palsy . Design : A single-blinded , r and omized controlled trial . Subjects : Forty-seven children ( 23 boys ; 24 girls ) with unilateral cerebral palsy , aged 6–12 years , were r and omized to constraint-induced therapy ( n = 24 ) or traditional rehabilitation ( n = 23 ) . Interventions : Constraint-induced therapy involved intensive functional training of the more affected arm while the less affected arm was restrained . Traditional rehabilitation involved functional unilateral and bilateral arm training . Both groups received individualized therapist-based interventions at home for 3.5–4 hours/day , two days a week for four weeks . Main measures : Motor performance and daily function were measured by the Peabody Developmental Motor Scale , Second Edition and the Pediatric Motor Activity Log . Reaching control was assessed by the kinematics of reaction time , movement time , movement unit and peak velocity . Results : There were larger effects in favour of constraint-induced therapy  on motor performance , daily function , and some aspects of reaching control compared with traditional rehabilitation .  Children  receiving constraint-induced therapy demonstrated higher scores for Peabody Developmental Motor Scale , Second Edition – Grasping ( pretest mean ± SD , 39.9 ± 3.1 ; posttest , 44.1 ± 2.8 ; P < 0.001 ) , Pediatric Motor Activity Log ( pretest , 1.8 ± 0.3 ; posttest , 2.5 ± 0.3 ; P < 0.001 ) and shorter reaction time , normalized movement time ( P < 0.001 ) and higher peak velocity ( P = 0.004 ) of reaching movement . Conclusions : Constraint-induced therapy induced better grasping performance , daily function , and temporal and spatiotemporal control of reaching in children with unilateral cerebral palsy than traditional rehabilitation To determine efficacy of pediatric Constraint-Induced Movement therapy , 20 children with congenital hemiparesis ( ages 2 to 6 years ) were r and omly assigned to receive the treatment or usual care . Controls crossed over to the therapy after 6 months . Children receiving the therapy first exhibited emergence of more new classes of motor patterns and skills ( eg , crawling , thumb-forefinger prehension ; 6.4 vs 0.02 , P < .0001 , effect size d = 1.3 ) , and demonstrated significant gains in spontaneous use of the more affected arm at home ( 2.2 vs 0.1 , P < .0001 , d = 3.8 ) and in a laboratory motor function test . Depending on the measure , benefits were maintained ( range , no loss to 68 % retention over 6 months ) . When controls crossed over to the therapy , they exhibited improvements as great as or greater than those receiving therapy first . Thus , Constraint-Induced Movement therapy appears to be efficacious for young children with hemiparesis consequent to congenital stroke Objectives . To determine retention of treatment outcomes at 52 weeks following a matched-pairs r and omized comparison trial of constraint-induced movement therapy ( CIMT ) and bimanual training ( BIM ) . Methods . Sixty-four children ( mean age = 10.2 ± 2.7 years , 52 % male ) were included . The Melbourne Assessment of Unilateral Upper Limb Function ( MUUL ) , Assisting H and Assessment ( AHA ) , and Canadian Occupational Performance Measure ( COPM ) were the primary outcome measures . Evaluations were at baseline and at 26 and 52 weeks . Results . There were no baseline differences between groups on any measure . No significant differences were found between groups on primary outcomes at 52 weeks . Both groups retained the significant gains made from baseline to 26 weeks at the 1-year follow-up assessment for unimanual capacity on the MUUL , for bimanual performance on the AHA , and on the COPM . Conclusion . Intensive unimanual and bimanual training can both lead to long-term significant improvements in unimanual capacity , bimanual performance , and individualized outcomes . Gains established at 26 weeks were maintained at 12 months postintervention despite most children receiving no direct therapy during that time Purpose . The aim of this study was to investigate the feasibility of implementing constraint-induced movement therapy ( CIMT ) in Jordan , a country with a different culture to that of the western world where CIMT has previously been investigated . Method . Twenty children with unilateral cerebral palsy ( CP ) were r and omised to either CIMT or neurodevelopmental treatment ( NDT ) . NDT is the usual treatment method in Jordan for children with CP and was used in the control group . Fourteen children fulfilled the treatment ; mean age was 47 months ( SD 19 months ) in the CIMT group and 65 months ( SD26 months ) in the NDT group . Jordanian therapists learned the CIMT method in a 2-day workshop . CIMT was based on 2-h per day for eight weeks , with the families being responsible for the training aside from a weekly session with the therapist , i.e. a home-based model . Children in the NDT group had 2 h of training per week by therapists . Results . H and function , measured with Assisting H and Assessment on a scale of 0–100 AHA-units , improved from 41.6 ( 12.6 ) to 48 ( 11.6 ) in the CIMT group and from 56 ( 18.7 ) to 56.6 ( 18.8 ) among controls . ANOVA show a group effect of treatment ( F(1,12 ) = = 7.77 ; p = = 0.016 ) . Conclusions . A treatment effect of CIMT can be seen after a 2-day workshop in a novel environment
QUESTIONS Does constraint-induced movement therapy improve activity and participation in children with hemiplegic cerebral palsy ?
Does it improve activity and participation more than the same dose of upper limb therapy without restraint ?
Is the effect of constraint-induced movement therapy related to the duration of intervention or the age of the children ?