Article

OBJECTIVE: To delineate characteristics of best responders in a randomized trial
comparing constraint-induced movement therapy (CIMT) to bimanual training for
children with unilateral cerebral palsy. DESIGN: Secondary analysis of a
single-blind matched-pairs randomized comparison trial. SETTING: Community
sporting facilities in 2 Australian capital cities. PARTICIPANTS: Children (n=64;
mean age, 10.2+/-2.7y; 52% boys), matched for age, sex, side of hemiplegia, and
upper-limb function, were randomized within pairs to CIMT or bimanual training.
Sixty-one children who completed CIMT (n=31) or bimanual training (n=30) were
included in this study. INTERVENTIONS: Each intervention was delivered in day
camps (total 60h over 10d) using a novel circus theme with goal-directed
training. MAIN OUTCOME MEASURES: Change between baseline, 3, and 26 weeks on the
Melbourne Assessment of Unilateral Upper Limb Function (MUUL>7.4%), Assisting
Hand Assessment (AHA>4 raw score points), and Canadian Occupational Performance
Measure (COPM>2 points) defined best responders. RESULTS: Poorer baseline hand
function predicted a best response for unimanual capacity of the impaired upper
limb (MUUL) immediately postintervention; however, at 26 weeks the odds of
achieving a favorable outcome were 21 times greater for CIMT than bimanual
training. A favorable response for bimanual performance (AHA) was predicted by
immediate change in Jebsen-Taylor hand function test scores. Age (older),
left-sided hemiplegia, and lower-baseline COPM performance scores significantly
predicted favorable individualized outcomes. CONCLUSIONS: Secondary analysis of a
randomized trial directly comparing 2 upper-limb training models, found children
with poorer hand function benefited most. Favorable outcomes for bimanual
performance were associated with gains in movement efficiency and older children
with left-sided hemiplegia achieved more favorable gains in perceived
occupational performance.
CI - Copyright (c) 2011 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS