Randomized trial of constraint-induced movement therapy and bimanual training on activity outcomes for children with congenital hemiplegia

Authors

  • LEANNE SAKZEWSKI,

    1.  Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, Faculty of Health, The University of Queensland, Brisbane, Qld, Australia
    2.  Brain Research Institute, Florey Neuroscience Institutes (Austin), Melbourne, Vic., Australia
    3.  School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Qld, Australia
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  • JENNY ZIVIANI,

    1.  School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Qld, Australia
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  • DAVID F ABBOTT,

    1.  Brain Research Institute, Florey Neuroscience Institutes (Austin), Melbourne, Vic., Australia
    2.  Department of Medicine, The University of Melbourne, Melbourne, Vic., Australia
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  • RICHARD A L MACDONELL,

    1.  Brain Research Institute, Florey Neuroscience Institutes (Austin), Melbourne, Vic., Australia
    2.  Department of Medicine, The University of Melbourne, Melbourne, Vic., Australia
    3.  Department of Neurology, Austin Health, Heidelberg, Vic., Australia
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  • GRAEME D JACKSON,

    1.  Brain Research Institute, Florey Neuroscience Institutes (Austin), Melbourne, Vic., Australia
    2.  Department of Medicine, The University of Melbourne, Melbourne, Vic., Australia
    3.  Department of Radiology, The University of Melbourne, Melbourne, Vic., Australia.
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  • ROSLYN N BOYD

    1.  Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, Faculty of Health, The University of Queensland, Brisbane, Qld, Australia
    2.  Brain Research Institute, Florey Neuroscience Institutes (Austin), Melbourne, Vic., Australia
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  • This article is commented on by Gordon on page 292 of this issue.

Dr Roslyn Boyd at Queensland Cerebral Palsy and Rehabilitation Research Centre, Department of Paediatrics and Child Health, Level 3, Foundation Building, Royal Children’s Hospital, Herston Road, Herston, Qld 4029, Australia. Email: r.boyd@uq.edu.auThis article is commented on by Gordon on page 292 of this issue.

Abstract

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 randomized trial.

Method  Sixty-three children (mean age 10.2, SD 2.7, range 5–16y; 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 randomly 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 Hand Assessment evaluated bimanual coordination at baseline, 3 and 26 weeks, scored by blinded raters.

Results  After concealed random 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.

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