Advertisement

Participation Outcomes in a Randomized Trial of 2 Models of Upper-Limb Rehabilitation for Children With Congenital Hemiplegia

  • Leanne Sakzewski
    Correspondence
    Correspondence to Leanne Sakzewski, PhD, B.OccThy, Queensland Centre of Cerebral Palsy and Rehabilitation Research Centre, Dept of Paediatrics and Child Health, The University of Queensland, Level 3, Foundation Building, Royal Children's Hospital, Herston Rd, Herston, QLD 4029, Australia Reprints are not available from the author
    Affiliations
    Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, Faculty of Health, The University of Queensland, Brisbane, Queensland, Australia

    School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia

    Brain Research Institute, Florey Neuroscience Institutes (Austin), Melbourne, Victoria, Australia
    Search for articles by this author
  • Jenny Ziviani
    Affiliations
    School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
    Search for articles by this author
  • David F. Abbott
    Affiliations
    Brain Research Institute, Florey Neuroscience Institutes (Austin), Melbourne, Victoria, Australia

    Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
    Search for articles by this author
  • Richard A. Macdonell
    Affiliations
    Brain Research Institute, Florey Neuroscience Institutes (Austin), Melbourne, Victoria, Australia

    Department of Radiology, The University of Melbourne, Melbourne, Victoria, Australia

    Department of Neurology, Austin Health, Heidelberg, Victoria, Australia
    Search for articles by this author
  • Graeme D. Jackson
    Affiliations
    Brain Research Institute, Florey Neuroscience Institutes (Austin), Melbourne, Victoria, Australia

    Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia

    Department of Radiology, The University of Melbourne, Melbourne, Victoria, Australia
    Search for articles by this author
  • Roslyn N. Boyd
    Affiliations
    Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, Faculty of Health, The University of Queensland, Brisbane, Queensland, Australia

    Brain Research Institute, Florey Neuroscience Institutes (Austin), Melbourne, Victoria, Australia
    Search for articles by this author

      Abstract

      Sakzewski L, Ziviani J, Abbott DF, Macdonell RA, Jackson GD, Boyd RN. Participation outcomes in a randomized trial of 2 models of upper-limb rehabilitation for children with congenital hemiplegia.

      Objective

      To determine if constraint-induced movement therapy (CIMT) is more effective than bimanual training to improve occupational performance and participation in children with congenital hemiplegia.

      Design

      Single-blind randomized comparison trial with evaluations at baseline, 3, and 26 weeks.

      Setting

      Community facilities in 2 Australian states.

      Participants

      Referred sample of children (N=64; mean age ± SD, 10.2±2.7y, 52% boys) were matched for age, sex, side of hemiplegia, and upper-limb function and were randomized to CIMT or bimanual training. After random allocation, 100% of CIMT and 94% of the bimanual training group completed the intervention.

      Interventions

      Each intervention was delivered in day camps (total 60h over 10d) using a circus theme with goal-directed training. Children receiving CIMT wore a tailor-made glove during the camp.

      Main Outcome Measures

      The primary outcome was the Canadian Occupational Performance Measure (COPM). Secondary measures included the Assessment of Life Habits (LIFE-H), Children's Assessment of Participation and Enjoyment, and School Function Assessment.

      Results

      There were no between-group differences at baseline. Both groups made significant changes for COPM performance at 3 weeks (estimated mean difference =2.9; 95% confidence interval [CI], 2.3–3.6; P<.001 for CIMT; estimated mean difference=2.8; 95% CI, 2.2–3.4; P<.001 for bimanual training) that were maintained at 26 weeks. Significant gains were made in the personal care LIFE-H domain following CIMT (estimated mean difference=0.5; 95% CI, 0.1–0.9; P=.01) and bimanual training (estimated mean difference=0.6; 95% CI, 0.2–1.1; P=.006).

      Conclusions

      There were minimal differences between the 2 training approaches. Goal-directed, activity-based, upper-limb training, addressed through either CIMT or bimanual training achieved gains in occupational performance. Changes in participation on specific domains of participation assessments appear to correspond with identified goals.

      Key words

      List of Abbreviations:

      CAPE (Children's Assessment of Participation and Enjoyment), CI (confidence interval), CIMT (constraint-induced movement therapy), COPM (Canadian Occupational Performance Measure), GAS (goal attainment scaling), ICF (International Classification of Functioning, Disability and Health), LIFE-H (Assessment of Life Habits), SFA (School Function Assessment), TDC (typically developing children), UL (upper limb)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • World Health Organisation
        International Classification of Functioning, Disability and Health.
        Geveva: WHO. 2001;
        • Sakzewski L.
        • Ziviani J.
        • Boyd R.
        The relationship between unimanual capacity and bimanual performance in children with congenital hemiplegia.
        Dev Med Child Neurol. 2010; 52: 811-816
        • Beckung E.
        • Hagberg G.
        Neuroimpairments, activity limitations, and participation restrictions in children with cerebral palsy.
        Dev Med Child Neurol. 2002; 44: 309-316
        • Wright F.V.
        • Rosenbaum P.L.
        • Goldsmith C.H.
        • Law M.
        • Fehlings D.L.
        How do changes in body functions and structures, activity, and participation relate in children with cerebral palsy?.
        Dev Med Child Neurol. 2008; 50: 283-289
        • Brown M.
        • Gordon W.A.
        Impact of impairment on activity patterns of children.
        Arch Phys Med Rehabil. 1987; 68: 828-832
        • Margalit M.
        Leisure activities of cerebral palsied children.
        Isr J Psychiatry Relat Sci. 1981; 18: 209-214
        • Sakzewski L.
        • Ziviani J.
        • Boyd R.
        Systematic review and meta-analysis of therapeutic management of upper limb dysfunction in children with congenital hemiplegia.
        Pediatrics. 2009; 123: e1111-e1122
        • Wallen M.
        • Ziviani J.
        • Herbert R.
        • Evans R.
        • Novak I.
        Modified constraint-induced therapy for children with hemiplegic cerebral palsy: a feasibility study.
        Dev Neurorehabil. 2009; 11: 124-133
        • Sutcliffe T.L.
        • Gaetz W.C.
        • Logan W.J.
        • Cheyne D.O.
        • Fehlings D.L.
        Cortical reorganization after modified constraint-induced movement therapy in pediatric hemiplegic cerebral palsy.
        J Child Neurol. 2007; 22: 1281-1287
        • Martin A.
        • Burtner P.A.
        • Poole J.
        • Phillips J.
        Case report: ICF-level changes in a preschooler after constraint-induced movement therapy.
        Am J Occup Ther. 2004; 62: 282-288
        • Aarts P.B.
        • Jongerius P.H.
        • Geerdink Y.A.
        • van Limbeek J.
        • Geurts A.C.
        Effectiveness of modified constraint-induced movement therapy in children with unilateral spastic cerebral palsy: a randomized controlled trial.
        Neurorehabil Neural Repair. 2010; 24: 509-518
        • Boyd R.
        • Sakzewski L.
        • Ziviani J.
        • et al.
        INCITE: A randomised trial comparing constraint induced movement therapy and bimanual training in children with congenital hemiplegia.
        BMC Neurol. 2010; 10: 4
        • Sakzewski L.
        • Ziviani J.
        • Abbott D.F.
        • Macdonell R.A.L.
        • Jackson G.D.
        • Boyd R.N.
        One hand or Two?.
        Dev Med Child Neurol. 2010; (In press)
        • Law M.
        • Baptiste S.
        • McColl M.
        • Opzoomer A.
        • Polatajko H.
        • Pollock N.
        The Canadian occupational performance measure: an outcome measure for occupational therapy.
        Can J Occup Ther. 1990; 57: 82-87
        • Sakzewski L.
        • Boyd R.
        • Ziviani J.
        Clinimetric properties of participation measures for 5- to 13-year-old children with cerebral palsy: a systematic review.
        Dev Med Child Neurol. 2007; 49: 232-240
        • Wallen M.
        • O'Flaherty S.J.
        • Waugh M.C.
        Functional outcomes of intramuscular botulinum toxin type A and occupational therapy in the upper limbs of children with cerebral palsy: a randomized controlled trial.
        Arch Phys Med Rehabil. 2007; 88: 1-10
        • Law M.
        • Baptiste S.
        • Carswell A.
        • McColl M.
        • Polatajko H.
        • Pollock N.
        Canadian occupational performance measure. 3rd ed.
        Ottawa: CAOT Publications ACE. 1998;
        • Fougeyrollas P.
        • Noreau L.
        • Lepage C.
        Assessment of life habits, children long form.
        Quebec: Reseau international sur le Processus de production du handicap/International Network on the Disability Creation Process. 2002;
        • Mihaylov S.I.
        • Jarvis S.N.
        • Colver A.F.
        • Beresford B.
        Identification and description of environmental factors that influence participation of children with cerebral palsy.
        Dev Med Child Neurol. 2004; 46: 299-304
        • Hammal D.
        • Jarvis S.N.
        • Colver A.F.
        Participation of children with cerebral palsy is influenced by where they live.
        Dev Med Child Neurol. 2004; 46: 292-298
        • Whiteneck G.
        • Harrison-Felix C.
        • Mellick D.
        • Brooks C.
        • Charlifue S.
        • Gerhart K.
        Quantifying environmental factors: a measure of physical, attitudinal, service, productivity, and policy barriers.
        Arch Phys Med Rehabil. 2004; 85: 1324-1335
        • Australian Bureau of Statistics
        Census of Population and Housing: Socio-Economic Indexes for Areas (SEIFA), 2006.
        Canberra: Australian Bureau of Statistics. 2008;
        • Schulz K.
        • Altman D.
        • Moher D.
        • CONSORT Group
        CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials.
        BMC Med. 2010; 8: 18
        • Liang K.
        • Zeger S.
        Longitudinal data analysis using generalized linear models.
        Biometrika. 1986; 73: 13-22
        • Majnemer A.
        • Shikako-Thomas K.
        • Chokron N.
        • et al.
        Leisure activity preferences for 6- to 12-year-old children with cerebral palsy.
        Dev Med Child Neurol. 2009; 52: 167-173
        • Coster W.
        • Khetani M.A.
        Measuring participation of children with disabilities: issues and challenges.
        Disabil Rehabil. 2008; 30: 639-648