The Hand Functions In Cerebral Palsy

Study Overview
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Brief Summary
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The hand motor functions are very important in the daily life activities, educational, and social participation of children. Losing The hand motor functions limit these activities and participation. Constraint-induced movement therapy (CIMT) or virtual reality (VR) therapy has often been preferred to improve the hand's motor functions.

Detailed Description
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CIMT and VR are used to improve the motor functions of the hand in cerebral palsy (CP). The aim of this study was to compare the effects of CIMT-VR use and only CIMT use on hand functions in children with hemiparetic cerebral palsy. Hand function and performance were evaluated with the Jebsen-Taylor and Moberg pick-up tests. All evaluations were made twice; before the first therapy and after six weeks. Children with hemiparetic CP were divided into three groups randomly (Traditional techniques (TT), TT+CIMT, and TT+CIMT+VR).

Official Title
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Which One is The Most Effective On The Hand Functions In Cerebral Palsy: Constraint-Induced Movement Therapy or Constraint-Induced Movement Therapy With Virtual Reality? A Randomized Controlled Trial.

Conditions
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Cerebral Palsy, Hand Functions

Intervention / Treatment
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* Other: TT+CIMT+VR
* Other: TT+CIMT
* Other: TT


Participation Criteria
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Eligibility Criteria
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The inclusion criteria of the study were determined to be aged 8 to 18 years, diagnosed with hemiparetic CP, being level 2 or 3 according to the gross motor function measurement scale and the manual ability classification system. The exclusion criteria of the study were, severe cognitive dysfunction that rendered them unable to perform simple tasks (e.g., reaching, grasping), having pharmacologic medicine for spasticity, having botulinum toxin A injections in the last 6 months, having upper extremity surgery, having visual and/or auditory problems which affect therapy or evaluation.

Ages Eligible for Study
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Minimum Age: 8 Years
Maximum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: traditional therapy with constraint induced movement therapy and virtual reality<br>After the TT session, a child with CP used the sling for 45 minutes at the rehabilitation center with VR therapy. VR therapy with CIMT was used in hands therapy for 45 minutes at two days a week after TT. During the VR therapy, the child was encouraged verbally to play X-box.The X-box Kinect 360 (by the Microsoft corporation) was used for VR therapy. It has a kinetic sensor that perceives the movement of the child with CP. The child's movement can be seen through the monitor in real time. VR does not need special buttons to play. Therefore, a child with CP who had impaired fine motor skills and dexterity can play easily. | Other: TT+CIMT+VR<br>* TT: Traditional Techniques CIMT: constraint-induced movement therapy VR: virtual reality<br>|
| Active Comparator: Traditional techniques<br>TT was planned according to the child's hand that was needed. Neurodevelopmental facilitation techniques (Bobath therapy), stretching, and grasping types (cylindrical, spherical, hook, key, fingertip, lateral) were used in hands therapy for 45 minutes two days in a week for all children who were accepted to participate in this study. | Other: TT<br>* TT: Traditional Techniques<br>|
| Experimental: traditional therapy with constraint induced movement therapy<br>The sling was put on the child's non-paretic arm to apply CIMT. The around of the sling was sewn except the elbow and secured snugly to the trunk with a waist strap to prevent assisting the affected hand during the application of CIMT. However, children with CP who were in the this group used the sling for three hours in daily activity, playing, etc. at home. The CIMT was given as a home program and monitorization was done by the follow-up form every week with no therapy during the weekend. | Other: TT+CIMT<br>* TT: Traditional Techniques CIMT: constraint-induced movement therapy<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The Jebsen-Taylor Test | The Jebsen-Taylor Test is a reliable tool that evaluates the hand function of children with CP. The test includes seven items. These items are; writing a 24-letter sentence, turning over five cards, picking up small objects (two pieces of pennies/bottle caps/paperclips), simulated feeding (using a teaspoon and five kidney beans), stacking four checkers, picking up and moving five large empty tin boxes and then five large full boxes. During the assessment, the child with CP was seated in front of a table and test was performed by hemiparetic hand. Time was recorded on each item by stopwatch. The total score was calculated by collecting all items' time. | this evaluation was done twice; before the first therapy and after six weeks by the same physiotherapist. | 
| Moberg pick-up test | To evaluate the functional performance of the hemiparetic hand Moberg pick-up test (MPUT) was used. MPUT consists of twelve items which are a wing nut, screw, key, nail, ₺1 coin, 50 kurus coin, washer, safety pin, paper clip, large and medium-sized hexagonal nut, and small square nut. The plastic container (60x30 cm) was placed lengthwise about 15 cm from the edge of the table on the opposite side of the items. The child was seated in a chair. The hemiparetic hand of children with CP was put on the same side as the 12 items which were randomly placed on the table. Children with CP were ordered to pick up the items one at a time and place them into the plastic container as fast as possible. The time was recorded with a stopwatch. | this evaluation was done twice; before the first therapy and after six weeks by the same physiotherapist. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Hand Functions, Virtual Reality, Constraint-Induced Movement Therapy, Cerebral Palsy, Rehabilitation