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
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Article info
Footnotes
Supported by the National Health and Medical Research Council of Australia (NHMRC) for Dora Lush postgraduate scholarship (scholarship no. NHMRC 384488), a Career Development (grant no. NHMRC 473860), and a project grant for INCITE: A Randomised Trial of Novel Upper Limb Rehabilitation in children with Congenital Hemiplegia (grant no. NHMRC 368500).
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.
Trial Registration Number: ANZCRT00320714.
Identification
Copyright
© 2011 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
