Constraint-induced Movement Therapy and Self-regulation for Children With Cerebral Palsy
Condition: Cerebral Palsy
MeSH terms: Cerebral Palsy
Study type: Interventional

Summary: 
      This study examines the effect of combining modified constraint-induced movement therapy
      (mCIMT) and self-regulation (SR) in promoting upper limb function of children with hemiplegic
      cerebral palsy (CP) studying in a school-based setting.
    

Detailed description: 
      Children diagnosed with hemiplegic CP are involved. A within-subject design is used with
      children acting as their own controls. The study is scheduled at three-week intervals. All
      children undergo conventional occupational therapy (OT) and modified constraint-induced
      movement therapy plus self-regulation (mCIMT + SR) program in a random order.

      Both programs last for three weeks. Each program is followed by a three-week no-treatment
      period to measure the carry-over effect. The OT program consists of training on unimanual and
      bimanual tasks for 1 to 2 hours a week with daily home exercise. The mCIMT + SR program
      involves restraint of the unaffected upper limb of children using a cotton sling for 6 hours
      per day for 15 days. A one-hour structured task practice with the use of SR is provided
      during each 6-hour restraint.

      The Bruininks-Oseretsky Test of Motor Proficiency, the Jebsen-Taylor Test of Hand Function,
      the Caregiver Functional Use Survey, a hand dynamometer, pinch gauge, and modified Ashworth
      scale are used for evaluation. All children are assessed for five times at 3-week interval:
      once before and twice after the conventional OT; and twice after the mCIMT + SR at 1 week and
      at 3 weeks.

      Before and after the three-week intervention, the children participate in event-related
      potentials (ERP) sessions with a choice reaction task. Event-related potentials (ERP)
      technique is used to capture the changes in neural mechanism after intervention.
    

Intervention name(s): mCIMT + SR; Control
Intervention type(s): Other; Other
Intervention description(s): Each participant wears a customized cotton sling on the unaffected arm for six hours everyday. Participant is engaged in fifteen unimanual tasks during the three-week training that provides them sufficient challenge and opportunities for repetition.
SR is incorporated on the 1-hour structured practice by using video playback to help participants realize their own performance for better learning. Participant first performs a task with videotaping, then identifies steps with problems or difficulties by video playback of participant's performance. Secondly, participant is asked for possible solutions, prompting is given if needed. Lastly, participant performs the activity by adopting the suggested solutions with videotaping again to facilitate participant's evaluation of new performance.; A combination of training on functional and remedial activities on unimanual tasks and bimanual tasks that based primarily on neurodevelopmental approach are provided. The training aims at increasing control, strength and functional use of their affected arm and hand, and improving bimanual coordination in performing daily activities. Each participant receives 1 to 2 hours of training per week at school. Home exercise including both unimanual and bimanual tasks is prescribed to them as well.
Other intervention name(s): Conventional occupational therapy
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment