Participation outcomes in a randomized trial of 2 models of upper-limb rehabilitation for children with congenital hemiplegia

Sakzewski, Leanne, Ziviani, Jenny, Abbott, David F., Macdonell, Richard A., Jackson, Graeme D. and Boyd, Roslyn N. (2011) Participation outcomes in a randomized trial of 2 models of upper-limb rehabilitation for children with congenital hemiplegia. Archives of Physical Medicine and Rehabilitation, 92 4: 531-539. doi:10.1016/j.apmr.2010.11.022

Author Sakzewski, Leanne
Ziviani, Jenny
Abbott, David F.
Macdonell, Richard A.
Jackson, Graeme D.
Boyd, Roslyn N.
Title Participation outcomes in a randomized trial of 2 models of upper-limb rehabilitation for children with congenital hemiplegia
Journal name Archives of Physical Medicine and Rehabilitation   Check publisher's open access policy
ISSN 0003-9993
Publication date 2011-04-01
Year available 2011
Sub-type Article (original research)
DOI 10.1016/j.apmr.2010.11.022
Open Access Status Not Open Access
Volume 92
Issue 4
Start page 531
End page 539
Total pages 9
Place of publication Maryland Heights, MO, United States
Publisher W.B. Saunders Co
Language eng
Subject 3612 Physical Therapy, Sports Therapy and Rehabilitation
2742 Rehabilitation
Abstract Congenital hemiplegia is the most common form of cerebral palsy (CP). Children with unilateral CP show signs of upper limb asymmetry by 8 months corrected age (ca) but are frequently not referred to therapy until after 12 months ca. This study compares the efficacy of infant-friendly modified constraint-induced movement therapy (Baby mCIMT) to infant friendly bimanual therapy (Baby BIM) on upper limb, cognitive and neuroplasticity outcomes in a multisite randomised comparison trial.
Formatted abstract
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 goaldirected
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.

Keyword Cerebral palsy
Randomized controlled trial
Upper extremity
Q-Index Code C1
Q-Index Status Confirmed Code
Grant ID NHMRC 384488
NHMRC 473860
NHMRC 368500
Institutional Status UQ
Additional Notes Presented in part to the Australasian Academy of Cerebral Palsy and Developmental Medicine, March 3–6, 2010, Christchurch, New Zealand; and the International Cerebral Palsy Conference, February 18–21, 2009, Sydney, Australia.

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2012 Collection
School of Health and Rehabilitation Sciences Publications
School of Medicine Publications
Version Filter Type
Citation counts: TR Web of Science Citation Count  Cited 35 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 41 times in Scopus Article | Citations
Google Scholar Search Google Scholar
Created: Thu, 16 Jun 2011, 00:38:14 EST by Ms Leanne Sakzewski on behalf of Paediatrics & Child Health - RBWH