A randomised controlled trial and systematic review comparing two methods of constraint induced movement therapy to improve upper limb function in pre-school children with hemiplegic cerebral palsy

摘要

Constraint induced movement therapy (CIMT) which is supported by motor learning theory has demonstrated promising results in improving upper limb function in hemiplegic cerebral palsy (HCP). However, its effectiveness within the NHS where children in the UK usually receive their therapy is little understood.ududTo provide clarification, the author conducted a randomised controlled trial (n = 62) in 16 NHS paediatric community therapy services which compared the feasibility and effectiveness of a novel approach (prolonged restraint) of CIMT with usual NHS practice, in the young child with HCP. The primary outcome was bimanual performance measured with the Assisting Hand Assessment (AHA).ududImmediately post-intervention both groups changed and although there was not a statistically significant group difference the prolonged restraint methodology resulted in a larger effect (0.5 versus 0.2). The novel approach was safe, feasible, and acceptable to families and a more effective method of treatment delivery. The trial findings were combined in a systematic review and meta-analysis with a similar study and a treatment effect of 0.92 AHA logits was demonstrated. This is compatible with the smallest detectable difference (0.97 logits) indicating actual change in bimanual performance.ududThe short-term efficacy, excellent recruitment and retention rates and acceptability of the trial procedures provides support for the trial feasibility and the need for a definitive investigation.ud