Article

Conventional constraint-based therapies are intensive and demanding to
implement, particularly for children. Modified forms of constraint-based
therapies that are family-centred may be more acceptable and feasible for
families of children with cerebral palsy (CP)-but require rigorous evaluation
using randomized trials.
The aim of this study was to determine the effects of
modified constraint-induced therapy compared with intensive occupational therapy
on activities of daily living and upper limb outcomes in children with hemiplegic
CP. METHOD: In this assessor-blinded pragmatic randomized trial, 50 children (27
males, 23 females; age range 19 mo-7 y 10 mo) with hemiplegic CP were randomized
using a concealed allocation procedure to one of two 8-week interventions:
intensive occupational therapy (n = 25), or modified constraint-induced therapy
(n = 25). Manual Ability Classification System (MACS) levels of the participants
were, level I n = 2, II n = 37, III n = 8, and level IV n = 1; Gross Motor
Function Classification System (GMFCS) levels were, level I n = 33, level II n =
15, and level III n = 1. Participants were recruited through three specialist CP
centres in Australia and randomized between January 2008 and April 2010. Children
randomized to modified constraint-induced therapy wore a mitt on the unaffected
hand for 2 hours each day, during which time the children participated in
targeted therapy. The primary outcome was the Canadian Occupational Performance
Measure (COPM--measured on a 10-point scale) at completion of therapy. Other
outcome measures were Goal Attainment Scaling, Assisting Hand Assessment,
Pediatric Motor Activity Log, Modified Ashworth Scale, Modified Tardieu Scale,
and a parent questionnaire. Assessments were carried out at 10 weeks and 6 months
following randomization. RESULTS: All participants were included in the analysis.
Between-group differences for all outcomes were neither clinically important nor
statistically significant. The mean difference in COPM was 0.3 (95% confidence
interval [CI] -0.8 to 1.4; p=0.61) and mean difference in COPM satisfaction was
0.1 (95% CI -1.1 to 1.2; p=0.90). Minor adverse events were reported by five of
the 25 participants in the modified constraint-induced therapy group and by one
of the 25 in the intensive occupational therapy group. All adverse events were
related to participants' lack of acceptance of therapy. INTERPRETATION: Modified
constraint-induced therapy is no more effective than intensive occupational
therapy for improving completion of activities of daily living or upper limb
function in children with hemiplegic CP.
CI - (c) The Authors. Developmental Medicine & Child Neurology (c) 2011 Mac Keith
Press.

Langue : ANGLAIS