Neuropediatrics 2011; 42 - V04
DOI: 10.1055/s-0031-1273953

Constraint-induced movement therapy versus bimanual therapy for children with central hemiparesis – relative effectiveness and factors of influence

W Deppe 1, K Thümmler 1, J Fleischer 1, C Berger 1, S Meyer 1
  • 1Neurologisches Rehabilitationszentrum für Kinder und Jugendliche Klinik Bavaria, Kreischa, Germany

Aims: The effectiveness of CIMT in children with unilateral cerebral palsy has been proven in several studies. Yet it is unclear whether the effectiveness is due to the restriction of the non-involved arm or to high therapy intensity. Therefore we have compared the effectiveness of our child-friendly interdisciplinary kid-CIMT program with an equally intensive bimanual therapy program (BT) and investigated influential factors.

Method:

  • Prospective controlled randomized interventional study.

  • 45 children, 3 to 12 years old

  • After assessments randomization for CIMT or BT

  • CIMT (n=25): 4 hrs daily single therapy over 3 weeks. In week 4 bimanual training of everyday life activities.

  • BT (n=20): 4 hrs daily single therapy over 4 weeks with emphasis on bimanual activities of daily living or playing

Tests and assessments:

  • Motor evoked potentials to judge cortical hand representation

  • Melbourne Assessment of Unilateral Upper Limb Function (MA)

  • Assisting Hand Assessment (AHA)

Results: For isolated motor functions of the paretic arm (MA) we found superiority of CIMT compared with BT: +6,6 vs. +2,3%-points pre-post difference (p<0,02).

Concerning bimanual everyday life and playing activities (AHA) we could not find significantly better outcome with CIMT: +6,2 vs. +4,6%-points (n.s.).

With respect to impairment severity a negative correlation for the AHA assessment turned out (r=-.50, p<0,02), that means children with more pronounced hand motor dysfunction took more benefit from therapy, especially in the CIMT group: comparing according initial AHA score 50% pat. with < median and 50% with > median: + 9,1 vs. + 4,1%.

No influence turned out for age and laterality of cortical control.

Summary: CIMT only yields better results than BT for isolated motor functions of the paretic arm, but not for integration of the paretic hand in everyday life and playing activities. However children with more pronounced hand dysfunction seem to take more benefit from CIMT. We conclude that motor therapy in hemiparetic children should be even more individually adjusted.