Overall, there are only small differences between constraint-induced movement therapy (CIMT) and bimanual training (BIM) in improving upper limb activity outcomes for children with congenital hemiplegia, say researchers in an article published in Developmental Medicine and Child Neurology. Results generally reflect specificity of practice, they add, with CIMT improving unimanual capacity and BIM improving bimanual performance.
For this study, researchers randomly allocated 63 children (mean age 10.2, SD 2.7, range 5-16 y; 33 boys, 30 girls), 16 in Manual Ability Classification System level I, 46 level II, and 1 level III, and 16 in Gross Motor Function Classification level I, 47 level II to either CIMT or BIM group day camps (60 hours over 10 days). The Melbourne Assessment of Unilateral Upper Limb Function assessed unimanual capacity of the impaired limb and Assisting Hand Assessment evaluated bimanual coordination at baseline, 3 and 26 weeks, scored by blinded raters.
After concealed random allocation, there was no baseline difference between groups. CIMT had superior outcomes compared with BIM for unimanual capacity at 26 weeks (estimated mean difference [EMD] 4.4). There was no other significant difference between groups post-intervention. Both groups demonstrated significant improvements in bimanual performance at 3 weeks, with gains maintained by BIM at 26 weeks (EMD 2.3).