Mastery motivation: a way of understanding therapy outcomes for children with unilateral cerebral palsy Effectiveness of Constraint induced movement therapy as compared to bimanual therapy in Upper motor function outcome in child with hemiplegic Cerebral palsy Motor learning curve and long-term effectiveness of modified constraint-induced movement therapy in children with unilateral cerebral palsy: a randomized controlled trial. CONSORT 2010 Explanation and Elaboration: Updated guidelines for reporting parallel group randomised trials. Randomized comparison trial of density and context of upper limb intensive group versus individualized occupational therapy for children with unilateral cerebral palsy. Unimanual and Bimanual Intensive Training in Children With Hemiplegic Cerebral Palsy and Persistence in Time of Hand Function Improvement Functional impact of constraint therapy and bimanual training in children with cerebral palsy: a randomized controlled trial. Hand function in children with hemiplegic cerebral palsy: prospective follow-up and functional outcome in adolescence. 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 Comparison of dosage of intensive upper limb therapy for children with unilateral cerebral palsy: how big should the therapy pill be? Modified constraint-induced movement therapy versus intensive bimanual training for children with hemiplegia – a randomized controlled trial Efficacy of a hand-arm bimanual intensive therapy (HABIT) in children with hemiplegic cerebral palsy: a randomized control trial. Efficacy of Constraint-Induced Movement Therapy and Bimanual Training in Children with Hemiplegic Cerebral Palsy in an Educational Setting Efficacy of a child-friendly form of constraint-induced movement therapy in hemiplegic cerebral palsy: a randomized control trial. Equivalent Retention of Gains at 1 Year After Training With Constraint-Induced or Bimanual Therapy in Children With Unilateral Cerebral Palsy
Abstract Purpose : To investigate the impact of mastery motivation on occupational performance outcomes immediately following upper limb ( UL ) training and 6 months post-intervention for school-aged children with unilateral cerebral palsy . Method : This prediction study was a post-hoc analysis of a matched pairs r and omized comparison trial ( COMBiT Trial Registration : ACTRN12613000181707 ) . The Canadian Occupational Performance Measure ( COPM ) was administered at baseline , 13 and 26 weeks post-intervention . Parents completed the Dimensions of Mastery Question naire ( DMQ ) , Parenting Scale and a demographic question naire . Children ’s UL capacity and performance was assessed using the Melbourne Assessment of Unilateral UL Function and assisting h and assessment ( AHA ) . Regression models were fitted using generalized estimating equations to baseline , 13 and 26 week measurements . Results : Forty-six children ( 7.78 years SD 2.27 years , 31 males , Manual Ability Classification System I = 23 , II = 23 ) participated . Higher levels of bimanual performance ( AHA : β = 0.03 , p < 0.001 ) , greater object-oriented persistence ( DMQ : β = 0.31 , p = 0.05 ) , and treatment group allocation ( St and ard Care : β = 0.24 , p = 0.01 ) were positively associated with COPM performance scores post-intervention . Conclusions : Children ’s bimanual performance and persistence with object-oriented tasks significantly impact occupational performance outcomes following UL training . Predetermining children ’s mastery motivation along with bimanual ability may assist in tailoring of intervention strategies and models of service delivery to improve effectiveness . Implication s for Rehabilitation Children ’s object persistence and bimanual performance both impact upper limb training outcomes Working with children ’s motivational predispositions may optimize engagement and therapy outcomes . Supporting positive parenting styles may enhance a child ’s mastery motivation and persistence with difficult tasks Objective : This study aims at determining the effectiveness of constraint induced movement therapy as compared to bimanual therapy for improving functional status in children with hemiplegic cerebral palsy . Methods : This study was a r and omized control trial , children ( n = 20 ) with spastic hemiplegic cerebral palsy was r and omly allocated to CIMT ( constraint induced movement therapy ) and BMT ( bimanual therapy ) group . The children with spastic hemiplegia , age between 1.5 and 12 year and having 10 degrees of wrist extension and 10 degrees of finger extension were included in study . Treatment regime was two hours of daily training six days a week for two weeks . Constraint was applied to CIMT group for six hours . The outcome tool QUEST was used for baseline and post treatment assessment . Result : CIMT had superior outcome as compared to BMT in improving functional status ( p=0.007 ) . On QUEST tool grasp and dissociated movements results were significant ( p=0.005 ) and ( p=0.028 ) respectively . Weight bearing and protective extension result ed in no significant outcome ( p=0.080 ) and ( p=0.149 ) respectively . Dissociated movements and grasp are significantly improved but there is no difference for weight bearing and protective extension in CIMT treated group as compared to BMT treated group . Conclusion : CIMT approach is better in improving functional status of child with cerebral palsy as compared to BMT . Significant improvement in grasp and dissociated movement is noted in group of CIMT while there was no significant improvement in weight bearing and protective extension in CIMT group when compared to BMT . CIMT is considered the appropriate treatment approach for unilateral conditions while BMT for bilateral conditions 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 Overwhelming evidence shows the quality of reporting of r and omised controlled trials ( RCTs ) is not optimal . Without transparent reporting , readers can not judge the reliability and validity of trial findings nor extract information for systematic review s. Recent method ological analyses indicate that inadequate reporting and design are associated with biased estimates of treatment effects . Such systematic error is seriously damaging to RCTs , which are considered the gold st and ard for evaluating interventions because of their ability to minimise or avoid bias . A group of scientists and editors developed the CONSORT ( Consoli date d St and ards of Reporting Trials ) statement to improve the quality of reporting of RCTs . It was first published in 1996 and up date d in 2001 . The statement consists of a checklist and flow diagram that authors can use for reporting an RCT . Many leading medical journals and major international editorial groups have endorsed the CONSORT statement . The statement facilitates critical appraisal and interpretation of RCTs . During the 2001 CONSORT revision , it became clear that explanation and elaboration of the principles underlying the CONSORT statement would help investigators and others to write or appraise trial reports . A CONSORT explanation and elaboration article was published in 2001 alongside the 2001 version of the CONSORT statement . After an expert meeting in January 2007 , the CONSORT statement has been further revised and is published as the CONSORT 2010 Statement . This up date improves the wording and clarity of the previous checklist and incorporates recommendations related to topics that have only recently received recognition , such as selective outcome reporting bias . This explanatory and elaboration document-intended to enhance the use , underst and ing , and dissemination of the CONSORT statement-has also been extensively revised . It presents the meaning and rationale for each new and up date d checklist item providing examples of good reporting and , where possible , references to relevant empirical studies . Several examples of flow diagrams are included . The CONSORT 2010 Statement , this revised explanatory and elaboration document , and the associated website ( www.consort-statement.org ) should be helpful re sources to improve reporting of r and omised trials AIM To determine whether short-term intensive group-based therapy combining modified constraint-induced movement therapy and bimanual therapy ( hybrid-CIMT ) is more effective than an equal total dose of distributed individualized occupational therapy ( st and ard care ) on upper limb motor and individualized outcomes . METHOD Fifty-three children with unilateral cerebral palsy ( 69 % males ; mean age 7y 10mo , SD 2y 4mo ; Manual Ability Classification System level I , n=24 ; level II , n=23 ) were r and omly allocated , and 44 received either hybrid-CIMT  ( n=25 ) or st and ard care ( n=19 ) . St and ard care comprised six weekly occupational therapy sessions and a 12-week home programme . Outcomes were assessed at baseline , 13 weeks , and 26 weeks after treatment . RESULTS Groups were equivalent at baseline . St and ard care achieved greater gains on satisfaction with occupational performance after intervention ( estimated mean difference -1.2 , 95 % CI -2.2 to -0.1 ; p=0.04 ) and Assisting H and Assessment at 26 weeks ( estimated mean difference 3.1 , 95 % CI 0.2 - 6.0 ; p=0.04 ) . Both groups demonstrated significant improvements in dexterity of the impaired upper limb , and bimanual and occupational performance over time . The differences between groups were not clinical ly meaningful . INTERPRETATION There were no differences between the two models of therapy delivery . Group-based intensive camps may not be readily available ; however , individualized st and ard care augmented with a home programme may offer an effective alternative but needs to be provided at a sufficient dose 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 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 The aim of this prospect i ve study was to determine the outcome of affected h and impairment and disability in a group of 31 children ( 16 males , 15 females ) with hemiplegic cerebral palsy who were referred consecutively to our rehabilitation service and followed from a mean age of 2 years and 7 months to a mean age of 12 years and 9 months . The h and function assessment protocol consisted of video-recorded procedures : one to assess grip and the other to assess the extent of spontaneous use of the affected h and . Assessment s at outset and at latest follow-up showed that the series as a whole had greater h and impairment in spontaneous manipulation than in gripping tasks . Comparison of h and function before age 4 years with the latest assessment over age 11 years revealed a non-significant improvement in grip , whereas spontaneous h and use remained stable . All but one of the children who had good grip and h and use scores at first assessment maintained them over time unless they were not treated for h and dysfunction . Among the children with low scores at outset , the improvement over time was more marked in grip than spontaneous h and use and occurred mainly in the early years . These results suggest that to evaluate the real disability of the affected h and in children with hemiplegia , grip assessment is insufficient and that an instrument assessing spontaneous h and use in bilateral manipulation is required . Furthermore , intensive treatment focused on h and function should be planned in the early years for children with more severe h and impairment , whereas regular follow-up is sufficient for less affected children 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 This study aim ed to compare efficacy of two dosages of modified constraint induced movement therapy ( mCIMT ) and bimanual therapy on upper limb and individualized outcomes for children with unilateral cerebral palsy . This secondary analysis included two separate r and omized trials that compared equal doses ( high or low ) of mCIMT to bimanual therapy ; Study 1 ( full dose--60 h ) n=64 and ; Study 2 ( half dose--30 h ) n=18 for children aged five to 16 years with unilateral cerebral palsy . Outcomes for both studies included the Melbourne Assessment of Unilateral Upper Limb Function , Assisting H and Assessment , Jebsen Taylor Test of H and Function and Canadian Occupational Performance Measure which were administered at baseline , three and 26 weeks . Mixed linear modelling was used to compare between dose ( e.g. " full dose " to " half dose " of either mCIMT or bimanual therapy ) on outcomes at three and 26 weeks post-intervention . There were no significant differences between groups at baseline , however , on average the half dose mCIMT group was younger with better h and function compared to the other groups . The full compared to half dose mCIMT group achieved greater gains in bimanual performance at three weeks and dexterity and quality of movement at 26 weeks . There were no between group differences for bimanual therapy doses . Half dose groups receiving either mCIMT or bimanual therapy did not make significant within group gains on any upper limb motor outcome , however gains in occupational performance were clinical ly meaningful . These results suggest that a half dose ( 30 h ) of either mCIMT or bimanual therapy may not be sufficient to impact upper limb outcomes , but made clinical ly meaningful gains in occupational performance for school aged children with UCP 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 Children with hemiplegic cerebral palsy ( CP ) have impairments in bimanual coordination above and beyond their unilateral impairments . Recently we developed h and -arm bimanual intensive therapy ( HABIT ) , using the principles of motor learning , and neuroplasticity , to address these bimanual impairments . A single-blinded r and omized control study of HABIT was performed to examine its efficacy in children with hemiplegic CP with mild to moderate h and involvement . Twenty children ( age range 3 y 6 mo-15 y 6 mo ) were r and omized to either an intervention ( n=10 : seven males , three females ; mean age 8 y 7 mo , SD 4 y ) or a delayed treatment control group ( n=10 : seven males , three females ; mean age 6 y 10 mo , SD 2 y 4 mo ) . Children were engaged in play and functional activities that provided structured bimanual practice 6 hours per day for 10 days . Each child was evaluated immediately before and after the intervention , and again at 1-month post-intervention . Children in the intervention group demonstrated improved scores on the Assisting H and Assessment , increased involved extremity use measured using accelerometry and a caregiver survey , bimanual items of the Bruininks-Oseretsky Test of Motor Proficiency , and the simultaneity of completing a draw-opening task with two h and s ( p<0.05 in all cases ) . The results suggest that for this carefully selected subgroup of children with hemiplegic CP , HABIT appears to be efficacious in improving bimanual h and use 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 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 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
Objective : To systematic ally review the evidence on the effect of constraint-induced movement therapy compared with bimanual intensive training in children with unilateral cerebral palsy .