Combining Unimanual and Bimanual Therapies for Children with Hemiparesis: Is There an Optimal Delivery Schedule?

Constraint-induced movement therapy (CIMT) and bimanual therapy (BT) are among the most effective hand therapies for children with unilateral cerebral palsy (uCP). Since they train different aspects of hand use, they likely have synergistic effects. The aim of this study was to examine the efficacy...

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Bibliographic Details
Published in:Behavioral sciences 2023-06, Vol.13 (6), p.490
Main Authors: Au, Ka Lai K, Knitter, Julie L, Morrow-McGinty, Susan, Campos, Talita C, Carmel, Jason B, Friel, Kathleen M
Format: Article
Language:English
Subjects:
Caregivers
cerebral palsy
Children
Children & youth
Communications industry
constraint
Evidence-based medicine
Hands
Health aspects
hemiplegia
Intervention
Occupational therapy
Telecommunications services industry
Therapists
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Summary:Constraint-induced movement therapy (CIMT) and bimanual therapy (BT) are among the most effective hand therapies for children with unilateral cerebral palsy (uCP). Since they train different aspects of hand use, they likely have synergistic effects. The aim of this study was to examine the efficacy of different combinations of mCIMT and BT in an intensive occupational therapy program for children with uCP. Children ( = 35) participated in intensive modified CIMT (mCIMT) and BT, 6 weeks, 5 days/week, 6 h/day. During the first 2 weeks, children wore a mitt over the less-affected hand and engaged in functional and play activities with the affected hand. Starting in week 3, bimanual play and functional activities were added progressively, 1 hour/week. This intervention was compared to two different schedules of block interventions: (1) 3 weeks of mCIMT followed by 3 weeks of BT, and (2) 3 weeks of BT followed by 3 weeks of mCIMT. Hand function was tested before, after, and two months after therapy with the Assisting Hand Assessment (AHA), Pediatric Evaluation of Disability Inventory (PEDI), and Canadian Occupational Performance Measure (COPM). All three groups of children improved in functional independence (PEDI; < 0.031), goal performance (COPM Performance; < 0.0001) and satisfaction (COPM Satisfaction; < 0.0001), which persisted two months post-intervention. All groups showed similar amounts of improvement, indicating that the delivery schedule for mCIMT and BT does not significantly impact the outcomes.
ISSN:2076-328X
2076-328X
DOI:10.3390/bs13060490