Article

OBJECTIVE: To determine if constraint-induced movement therapy (CIMT) is more
effective than bimanual training to improve occupational performance and
participation in children with congenital hemiplegia. DESIGN: Single-blind
randomized comparison trial with evaluations at baseline, 3, and 26 weeks.
SETTING: Community facilities in 2 Australian states. PARTICIPANTS: Referred
sample of children (N=64; mean age +/- SD, 10.2+/-2.7y, 52% boys) were matched
for age, sex, side of hemiplegia, and upper-limb function and were randomized to
CIMT or bimanual training. After random allocation, 100% of CIMT and 94% of the
bimanual training group completed the intervention. INTERVENTIONS: Each
intervention was delivered in day camps (total 60 h over 10d) using a circus
theme with goal-directed training. Children receiving CIMT wore a tailor-made
glove during the camp. MAIN OUTCOME MEASURES: The primary outcome was the
Canadian Occupational Performance Measure (COPM). Secondary measures included the
Assessment of Life Habits (LIFE-H), Children's Assessment of Participation and
Enjoyment, and School Function Assessment. RESULTS: There were no between-group
differences at baseline. Both groups made significant changes for COPM
performance at 3 weeks (estimated mean difference =2.9; 95% confidence interval
[CI], 2.3-3.6; P<.001 for CIMT; estimated mean difference=2.8; 95% CI, 2.2-3.4;
P<.001 for bimanual training) that were maintained at 26 weeks. Significant gains
were made in the personal care LIFE-H domain following CIMT (estimated mean
difference=0.5; 95% CI, 0.1-0.9; P=.01) and bimanual training (estimated mean
difference=0.6; 95% CI, 0.2-1.1; P=.006). CONCLUSIONS: There were minimal
differences between the 2 training approaches. Goal-directed, activity-based,
upper-limb training, addressed through either CIMT or bimanual training achieved
gains in occupational performance. Changes in participation on specific domains
of participation assessments appear to correspond with identified goals.
CI - Copyright (c) 2011 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS