A newly published meta-analysis of randomized controlled trials (RCTs) supports the use of constraint-induced movement therapy (CIMT) for children with cerebral palsy as an effective intervention for upper-limb function, albeit one whose effectiveness isn't necessarily a slam dunk over other dose-equivalent approaches.
The study, e-published ahead of print in Clinical Rehabilitation (abstract only available for free) looked at 27 RCTs between 2004 and 2014 that included 894 participants with cerebral palsy ranging in age from 2.4 to 10.7 years. The majority of studies focused on a 5 day per-week intervention over the course of 2 to 3 weeks, and restraints included slings, gloves, mittens, and casts.
Authors write that the studies showed a medium effect of CIMT on arm function—results that they describe as "similar to the effect of [CIMT] when used in adults with stroke." When they applied the International Classification of Functioning, Disability and Health (ICF) model to the results, they found that CIMT resulted in medium improvements to activity level immediately after the intervention and to participation level during follow-up.
Effectiveness was also affected by location of the intervention, according to the study, with home-based settings producing better results than clinic or camp-based settings. "The natural environment … offered less distress during [CIMT] practice for both children with cerebral palsy and their parents," authors write. "Further the training schedule can be tailored to fit into the family's daily routine."
The CIMT approach didn't fare as well when a longer follow-up time was used, authors write, "consistent with the logical assumption that the [CMIT] effect could not be maintained over time." Additionally, when compared to dose-equivalent groups, the groups receiving CIMT showed only "slightly better" results, as opposed to the "large effect" noted when compared to interventions that were not dose equivalent.
Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.
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