Article

OBJECTIVE: To clarify whether modified constraint-induced movement therapy
provides greater improvement than intensive bimanual training both for motor
functions and spontaneous use of the paretic arm and hand in everyday life
activities. DESIGN: Randomized controlled, single-blind trial. SETTING: Inpatient
paediatric rehabilitation clinic. SUBJECTS: Forty-seven children with unilateral
cerebral palsy or other non-progressive hemiplegia (aged 3.3-11.4 years) were
randomly assigned to either a modified constraint-induced movement programme
(kid-CIMT) or intensive bimanual training. Interventions: Patients in the
kid-CIMT group received 60 hours of unilateral constraint-induced and 20 hours of
bimanual training over four weeks. Patients in the bimanual treatment group
received 80 hours of bimanual training over four weeks. MAIN OUTCOME MEASURES:
Melbourne Assessment of Unilateral Upper Limb Function and Assisting Hand
Assessment. RESULTS: Modified constraint-induced therapy provided a significantly
better outcome for isolated motor functions of the paretic arm than bimanual
training (gain in Melbourne Assessment, percent score: 6.6 vs. 2.3, P= 0.033).
Regarding spontaneous use both methods led to similar improvement (gain in
Assisting Hand Assessment, percent score: 6.2 vs. 4.6, P= 0.579). More-disabled
children showed greater improvement than less-disabled ones (correlation with
Assisting Hand Assessment pretreatment score r = -0.40). Age did not affect
treatment outcome. CONCLUSIONS: Modified constraint-induced movement therapy can
improve isolated functions of the hemiplegic arm better than intensive bimanual
training, but regarding spontaneous hand use in everyday life both methods lead
to similar improvement. Improvements are generally greater in more impaired
children. Age does not affect outcome.

Langue : ANGLAIS