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Multisite trial comparing the efficacy of constraint-induced movement therapy with that of bimanual intensive training in children with hemiplegic cerebral palsy : postintervention results

The aim of this study was to compare the effects of modified
constraint-induced movement therapy (mCIMT; restraint of unaffected limb combined
with unimanual intensive rehabilitation) with those of a bimanual intensive
rehabilitation treatment (IRP) in children with hemiplegic cerebral palsy after a
10-wk practice vs. standard treatment (ST). This study is a multicenter,
cluster-randomized controlled clinical trial of tested groups of children with
hemiplegic cerebral palsy treated using mCIMT, IRP, or ST. For 10 wks, in mCIMT
and IRP, the intensive practice lasted 3 hrs/day, 7 days/wk; in ST, 1-hr sessions
twice a week were provided. The primary outcomes are upper limb/hand function
(Quality of Upper Extremity Skills Test) and activities of daily living (Besta
Scale), which are assessed before and after treatment. One hundred five patients
were recruited, 39 to the mCIMT group, 33 to the IRP group, and 33 to the ST
group. RESULTS: IRP and mCIMT significantly improved paretic hand function both
in the Quality of Upper Extremity Skills Test and in the Besta Scale, whereas ST
did not. mCIMT improved grasp more than IRP did (P < 0.01), whereas bimanual
spontaneous use in play increased more with IRP (P = 0.0005). Activities of daily
living in 2- to 6-yr-olds improved more with IRP (P < 0.0001) than with mCIMT (P
= 0.011). Unaffected limb improved more from bimanual practice (IRP; P = 0.02).
CONCLUSIONS: More advantages resulted from intensive practice than in the
standard one, in mCIMT for grasp and in IRP for bimanual spontaneous use and
activities of daily living in younger children.

Langue : ANGLAIS

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