Article

AIM: To determine if constraint-induced movement therapy (CIMT) is more effective
than bimanual training (BIM) in improving upper limb activity outcomes for
children with congenital hemiplegia in a matched-pairs randomized trial. METHOD:
Sixty-three children (mean age 10.2, SD 2.7, range 5-16 y; 33 males, 30 females),
16 in Manual Ability Classification System level I, 46 level II, and 1 level III
and 16 in Gross Motor Function Classification level I, 47 level II) were randomly
allocated to either CIMT or BIM group day camps (60 hours over 10 days). The
Melbourne Assessment of Unilateral Upper Limb Function assessed unimanual
capacity of the impaired limb and Assisting Hand Assessment evaluated bimanual
coordination at baseline, 3 and 26 weeks, scored by blinded raters. RESULTS:
After concealed random allocation, there was no baseline difference between
groups. CIMT had superior outcomes compared with BIM for unimanual capacity at 26
weeks (estimated mean difference [EMD] 4.4, 95% confidence interval [CI] 2.2-6.7;
p < 0.001). There was no other significant difference between groups
post-intervention. Both groups demonstrated significant improvements in bimanual
performance at 3 weeks, with gains maintained by BIM at 26 weeks (EMD 2.3; 95% CI
0.6-4.0; p = 0.008). Interpretation Overall, there were only small differences
between the two training approaches. CIMT yielded greater changes in unimanual
capacity of the impaired upper limb compared with BIM. Results generally reflect
specificity of practice, with CIMT improving unimanual capacity and BIM improving
bimanual performance. Considerable inter-individual variation in response to
either intervention was evident. Future research should consider serial
sequencing unimanual then BIM approaches to optimize upper limb outcomes for
children with congenital hemiplegia.
CI - (c) The Authors. Journal compilation (c) Mac Keith Press 2011.

Langue : ANGLAIS