Efficacy of Constraint-Induced Movement Therapy Versus Bimanual Intensive Training on Motor and Psychosocial Outcomes in Children With Unilateral Cerebral Palsy: A Randomized Trial

Abstract

Abstract Importance: Emerging research has demonstrated that constraint-induced movement therapy (CIMT) and bimanual intensive training (BIT) show promising effectiveness for children with unilateral cerebral palsy (UCP). Considering that neurorehabilitative programs have always been designed with long training periods, psychosocial outcomes have received scarce attention and thus have not been investigated sufficiently. Objective: To compare the efficacy of CIMT and BIT with 36-hr interventional dosages for both motor and psychosocial outcomes. Design: Randomized trial. Setting: Community. Participants: Forty-eight children with UCP, ages 6 to 12 yr. Intervention: Both CIMT and BIT delivered via individual intervention for 2.25 hr/day, twice a week, for 8 wk. Outcomes and Measures: The Melbourne Assessment 2, Pediatric Motor Activity Log–Revised, Bruininks–Oseretsky Test of Motor Proficiency, ABILHAND–Kids measure, and Parenting Stress Index–Short Form were administrated at pretreatment, midterm, posttreatment, and 6 mo after intervention. An engagement questionnaire for investigating the child’s engagement in the intervention was used to collect the perspectives of the children and the parents weekly. Results: Children with UCP who received either CIMT or BIT achieved similar motor improvements. The only difference was that CIMT yielded larger improvements in frequency and quality of use of the more affected hand at the 6-mo follow-up. Similar child engagement and parental stress levels were found in the two groups. Conclusions and Relevance: This study comprehensively compared the efficacy of motor and psychosocial outcomes for 36-hr dosages of CIMT and BIT. The promising findings support the clinical efficacy and feasibility of the proposed protocols. What This Article Adds: The core therapeutic principle of CIMT (i.e., remind the child to use the more affected hand) may be more easily duplicated by parents. Parents may have overestimated their child’s engagement and given relatively higher scores; therefore, occupational therapists should also consider the opinions of the children themselves.