Comparison of CIMT and Its Modified Form on Upper Motor Function Outcomes in Hemiplegic Cerebral Palsy.
Condition: Hemiplegic Cerebral Palsy
MeSH terms: Paralysis; Cerebral Palsy
Study type: Interventional

Summary: 
      The aim of this research is to compare the effect of classic constraint-induced movement
      therapy and its modified form on upper extremity motor function outcomes and psychosocial
      impact in hemiplegic cerebral palsy. Randomized controlled trials with 2-3 weeks follow-up.
      The sample size is 40. The subjects are divided in two groups, 20 subjects in classical CIMT
      group and 20 in modified CIMT group. Study duration is of 6 months. Sampling technique
      applied will be purposive non probability sampling technique. Only 4-12 years individual with
      hemiplegic cerebral palsy are included. Tools used in the study are Box and Block test,
      Cerebral palsy (quality of life), Kid Screen 27 and QUEST (quality of upper extremity skill
      test). Data will be analyzed through SPSS 21.
    

Detailed description: 
      Cerebral palsy is known as a neurodevelopment disease that begins in the early childhood and
      persists throughout the life. In the past, it was a challenge to define the term CP. Many
      attempts were made to overcome this. In 1964, definition for cerebral palsy was given that is
      still used worldwide. According to that cerebral palsy (CP) is not just the disorder of
      posture but movement also and it happens due to lesion or damage of an immature brain. It is
      a disorder of human brain that is non-progressive. The main focus of the definition was on
      the motor impairment. Cerebral palsy can lead to activity limitation. As CP includes motor
      disorders so it encounters disturbances like cognition, sensation, communication, seizures
      and behavioral disorder.

      The frequency with which CP occurs is of importance as it is the first effort towards its
      prevention. It also estimates the supportive services and the medical care that is required
      for children with cerebral palsy and also their families. Many studies were conducted to
      check the trends of Cerebral Palsy occurrence depending upon the low birth weight.

      The definition of cerebral palsy shows that it is just a single disorder infect it is
      collection of disorders. Prevalence of cerebral palsy shows that out of 1000 births, there
      are 2.0-2.5 children are victims of cp. However in few children, the causes of CP are still
      not known. Moreover, the causes need to be discriminated from the risk factors. Prenatal
      events are also responsible for CP. Such events may include toxins, maternal infection for
      example rubella or brain malformations. One of the prenatal causes is birth asphyxia. A small
      ratio of CP can be the result of perinatal causes. 10% cases of cp are result of postnatal
      causes. The causes can be accidental or non-accidental. Meningitis is also one of the
      postnatal causes.

      Out of all types of cerebral palsy, one-third is spastic hemiplegic. Birth trauma can be the
      cause of spastic hemiplegia. Researches show that there is more ratio of right hemiplegia
      than the left hemiplegia. The most common form of CP that is seen in premature children is
      spastic diplegia. In spastic diplegia, spasticity affects lower limbs more than the upper
      extremity. Birth asphyxia is seen in children born with the choreo-athetosis.

      Traditional hemiplegic patients receive occupational and physical therapy to improve their
      functional skills. Constraint induced movement therapy (CIMT) is an approach to treating the
      hemiparesis that facilitate use of hemiparetic arm through constraint the unaffected arm.it
      has been shown to be effective treatment in hemiparesis in adult and children.

      In this study, I hypothesized that there is a difference between the effectiveness of classic
      CIMT with modified CIMT on upper extremity motor function outcomes in children with
      hemiplegic cerebral palsy. The purpose of this study is to compare the effects of classic
      CIMT with modified CIMT on upper extremity motor functions and to see the psychosocial impact
      of CIMT on hemiplegic cerebral palsy.

      LITERATURE REVIEW:

      There is injury of undeveloped brain in Children with CP. Children with hemiplegic cerebral
      palsy (HCP) have trouble using their affected arm and hand on one side of their body.
      Evidence from randomized controlled trials, clinical controlled trials, and systematic
      reviews has shown constraint therapy improves hand and arm movement in children with
      hemiplegic cerebral palsy. According to a research review done in 2014; it is seen that CIMT
      proved to be beneficial in improving hand function as compared to the conventional therapy. A
      comparison was done between equal intensity of bimanual training and CIMT. Results showed
      same progress in hand function.

      A comparison was done between equal intensity of hand arm bimanual training (HABIT) and CIMT.
      Results showed same progress in hand function. Modified constraint-induced movement therapy
      improved isolated functions of the hemiplegic arm better than intensive bimanual training,
      but regarding spontaneous hand use in everyday life both methods lead to similar improvement.
      This suggests mCIMT should be paired with BIT to achieve optimal results for children with
      HCP who present with difficulties in both unimanual and bimanual hand functions. A study
      combining mCIMT and BIT demonstrated more frequent and more effective use of the affected
      limb, and better performance inself-care and leisure tasks.

      Children and parents from both groups (CIMT and BIT) reported a significant improvement in
      their or their child's feelings about functioning as well as participation and physical
      health. The parents of children receiving CIMT reported positive and sustained changes in
      their child's social well-being (CPQOL-Child). The CIMT group showed significant improvements
      in physical well-being, psychological well-being, moods and emotions.
    

Intervention name(s): Classic CIMT group; Modified CIMT group
Intervention type(s): Other; Other
Intervention description(s): Constraint Induced Movement Therapy (CIMT) is a new treatment technique that claims to improve the arm motor ability and the functional use of a paretic arm - hand. CIMT forces the use of the affected side by restraining the unaffected side. Child with hemiplegic cerebral palsy can learn to improve the motor ability of the more affected parts of their bodies and thus cease to rely exclusively or primarily on the less affected parts.; Modified CIMT protocol that was based on suggestions made by Dromerick, Edwards, and Hahn (2000) . Modifications were reductions in the duration of mitt wear and massed practice compared with the traditional protocol
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Cerebral Palsy; Constraint-Induced Movement Therapy