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Evidence summaries

Constraintinduced Movement Therapy in Children with Unilateral Cerebral Palsy

For children with unilateral CP, constraint-induced movement therapy (CIMT) might possibly result in improved bimanual performance and unimanual capacity when compared to a low-dose comparison, but not when compared to a high-dose or dose-matched comparison, although the evidence is insufficient. Level of evidence: "D"

A Cochrane review [Abstract] 1 included 36 studies with a total of 1264 patients. Mean age was 5.96 years (range 3 months to 20 years). Average length of constraint-induced movement therapy (CIMT) programs was 4 weeks (range one to 10 weeks). Frequency and duration of intervention sessions and total number of hours of CIMT varied across studies. The most common constraint devices were a mitt/glove or a sling (11 studies each).

  • CIMT vs. low-dose comparison (e.g. occupational therapy): CIMT was more effective for improving bimanual performance (MD 5.44 Assisting Hand Assessment (AHA) units, 95% CI 2.37 to 8.51; 2 studies, n=39) and unimanual capacity (Quality of upper extremity skills test (QUEST) - Dissociated movement MD 5.95, 95% CI 2.02 to 9.87; 3 studies, n=121; Grasps; MD 7.57, 95% CI 2.10 to 13.05; 2 studies, n=103; Weight bearing MD 5.92, 95% CI 2.21 to 9.6; 2 studies, n=103; Protective extension MD 12.54, 95% CI 8.60 to 16.47; 2 studies, n=103).
  • CIMT vs. high-dose comparison (e.g. individualised occupational therapy, bimanual therapy): CIMT was not more effective for improving bimanual performance (MD −0.39 AHA Units, 95% CI −3.14 to 2.36; 3 studies, n=126) or unimanual capacity in a single study (n=34) using QUEST (Dissociated movement MD 0.49, 95% CI −10.71 to 11.69; Grasp MD −0.20, 95% CI −11.84 to 11.44).
  • CIMT vs. dose-matched comparison (e.g. Hand Arm Bimanual Intensive Therapy, bimanual therapy, occupational therapy): There were no differences between the groups in bimanual performance (MD 0.80 AHA units, 95% CI −0.78 to 2.38; 7 studies, n=229) or improving unimanual capacity (Box and Blocks Test MD 1.11, 95% CI −0.06 to 2.28; Melbourne Assessment MD 1.48, 95% CI −0.49 to 3.44; QUEST Dissociated movement MD 6.51, 95% CI −0.74 to 13.76; Grasp, MD 6.63, 95% CI −2.38 to 15.65; Weightbearing MD −2.31, 95% CI −8.02 to 3.40), except for the Protective extension domain (MD 6.86, 95% CI 0.14 to 13.58; 2 studies, n=82). There was no difference either in manual ability between the groups (ABILHAND-Kids MD 0.74, 95% CI 0.31 to 1.18; 2 studies, n=95).

Comment: The quality of evidence is downgraded by inconsistency (heterogeneity in interventions and outcomes), indirectness (short follow-up time) and imprecise results (few small studies for each comparison).

    References

    • Hoare BJ, Wallen MA, Thorley MN et al. Constraint-induced movement therapy in children with unilateral cerebral palsy. Cochrane Database Syst Rev 2019;4():CD004149. [PubMed]

Primary/Secondary Keywords