A critical appraisal of "Constraint-induced movement therapy (CIMT) for young children with cerebral palsy: effects of therapeutic dosage"

Abstract

The purpose of this study was to determine an effective dosage for constraint-induced movement therapy (CIMT) in pediatric patients with hemiplegic cerebral palsy (CP). This objective was achieved by randomly assigning subjects to either the high-dosage treatment group (6 hours/day) or the moderate-dosage treatment group (3 hours/day). The hypothesized outcome was that subjects in the high-dosage group would see greater improvements in functional upper arm movements following the 21 days of CIMT, including long-arm casting. Participants were assigned to one of three research sites where they underwent their therapy and were evaluated on baseline and progress via outcome measures 1- week prior, and 1-week and 1-month following treatment. The selected outcome measures were the Assisting Hand Assessment (AHA), the Quality of Upper Extremity Skills Test (QUEST), the Shriners Hospital Upper Extremity Evaluation (SHUEE) and the Pediatric Motor Activity Log (PMAL). Blinded physical and occupational therapists performed the evaluations while therapist involved in the treatment interventions had pediatric experience and underwent a training in the CIMT protocol used. There were 18 total participants, there was no subject attrition, and all participants completed all aspects of the treatment plan. The study found that both dosage groups demonstrated significant improvements on each outcome measure however, there were no significant differences dependent on dosage group. It was concluded that both high-dosage and moderate-dosage CIMT for treatment of pediatric patients with hemiplegic cerebral palsy were effective for improvements in functional upper arm movements. These results were not in concordance with the hypothesis but are clinically relevant. The authors suggested that future studies strive to evaluate the effects of alternative CIMT administration methods, more individualized CIMT programs and varied casting approaches including duration and technique.

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