Constraint-Induced Movement Therapy vs Bimanual Intensive Training in Hemiplegic Cerebral Palsy: preliminary results

OBJECTIVE: In children with hemiplegic cerebral palsy (CP), impairment of upper extremity (UE) both in strenght and motor control represents an obstacle to exploration, self-care, activities of daily living, represents a main target of several treatment approaches. Constraint Induced Movement Therapy (CIMT) is a promising approach, but its efficacy is still object of a debate. Aim of this study is to measure the effect of CIMT on patients with hemiplegic CP after the end of 10-weeks intensive treatment practice. DESIGN: Designed as a multi center, prospective, cluster-randomized controlled clinical trial. CIMT is compared with ah Intensive Rehabilitation Program (IRP) of bimanual training. Primary outcome measures concern UE motor ability (QUEST) and assessment of affected hand's function in spontaneous use (Besta Scale). Secondary outcome measures concern overall function, behavior, stress, compliance and satisfaction with treatment program of both child and family. RESULTS: 105 patients were recruited (treatment groups CIMT (n=39), bimanual IRP (n=33) and Standard Treatment (n=33)). Statistically significant changes are observed in the global score before and after treatment of the 2 groups (CIMT and IRP group) of children assessed with the Besta Scales (CIMT p=0.002; IRP p<0.0001, and QUEST (CIMT p<0.0001; IRP p=0.0143). In CIMT group the higher improvement is observed in grasp function (p=0.0019). In IRP group, the improvement is more significant in activities of spontaneous use (p=0.0005) and ADL in the younger (p=0.0001). In IRP group, children show a significant improvement in the non affected hand, while CIMT patients show worse function for grasp. CONCLUSIONS: Our results demonstrate that a substantial improvement of paretic hand function was observed in children treated both with constraint of the unaffected hand and intensive unilateral practice and those treated with intensive bilateral practice without restriction. CIMT results were particularly effective for grasp function, while IRP ameliorates ADL and spontaneous use.