Modified Constraint-Induced Movement Therapy in Children With Hemiparetic Cerebral Palsy
Condition: Spastic Hemiplegic Cerebral Palsy
MeSH terms: Cerebral Palsy
Study type: Interventional

Summary: 
      Cerebral palsy (CP) is defined as a non-progressive lesion of the developing foetal or infant
      brain and causes variety of motor, sensory and cognitive impairments. Hemiplegic CP is the
      most common type of CP in term infants, involving one half of the body. In these individuals,
      muscle tone is reduced, and there is an inability to perform quality upper extremity
      movements due to increased muscle tone, increased reflexes, weakness in antagonist muscles.
      Due to spasticity upper extremity is present in shoulder adduction and internal rotation,
      elbow flexion and pronation, wrist and fingers flexed and thumb in palm position. Spontaneous
      movements of the upper extremity are decreased and abnormal. These individuals have a reduced
      upper extremity function ranging from mild incompetence to almost no use of the hand.

      Constraint-Induced Movement Therapy (CIMT) is designed to improve the function of the most
      affected limb by restricting the use of the less affected limb in individuals with unilateral
      upper extremity involvement and implementing an intensive motor learning-based training
      program. In pediatric subjects, modified CIMT (mCIMT), which is called a 'child-friendly
      technique', has been applied, which shows some differences from the form of CIMT in adults.
      In mCIMT, the restriction time was reduced, activities with the child were performed within a
      play frame, in the environment in which the child was accustomed, and restriction methods
      such as gloves, splint, sling were used. In the literature CIMT has been used mainly in
      children with hemiplegic CP in the pediatric population. However, there are many studies in
      the literature evaluating the efficacy of mCIMT in individuals with hemiplegic CP and showing
      beneficial effects on upper extremity speed and skills, and the duration of application
      restriction varies considerably.

      The aim of the investigator's study was to determine the effect of consecutive or
      intermittent implementation of mCIMT on upper extremity function in children with hemiplegic
      CP. Thus, it will be determined whether the modification of the duration of administration in
      the pediatric population varies in treatment results.
    

Detailed description: 
      33 children with spastic hemiplegia age between 5-18 years will participate study. Children's
      gross motor skills classified with Gross Motor Classification Sysytem (GMFCS) and hand
      abilities classified with Manual Ability Classification System (MACS). The children divided
      into 3 groups, consecutive mCIMT group, intermittent mCIMT group, and traditional
      physiotherapy control group. The consecutive mCIMT group received mCIMT treatment for 10
      consecutive days in addition to the conventional physiotherapy sessions. A sling used to
      restrict the noninvolved upper extremity. The unaffected upper extremities of the children
      restricted for 6 hours and activities performed by using shaping techniques under the
      guidance of same therapist. Within the remaining period, the family implemented the
      activities with his/her child that are determined by the therapist using the motor learning
      principles, appropriate to the age of the child and that he / she likes to do. The
      assessments performed for all three groups before, 10 days after and 5 weeks after treatment.
    

Intervention name(s): Consecutive Modified Constraint-Induced Movement Therapy; Traditional physiotherapy; Intermittent Modified Constraint-Induced Movement Therapy
Intervention type(s): Other; Other; Other
Intervention description(s): Consecutive mCIMT group received 6 hours per day mCIMT sessions for consecutive 10 days. Accompanied by a physiotherapist in 1 hour of the 6-hour restriction period, the family was guided within the remaining period and the activities were adapted to daily life.; Traditional physiotherapy within a specific program; Intermittent mCIMT group received mCIMT session 6 hours per day for 10 days, spread over 5 weeks (two days per week). Accompanied by a physiotherapist in 1 hour of the 6-hour restriction period, the family was guided within the remaining period and the activities were adapted to daily life.
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment