Multisite Trial Comparing the Efficacy of Constraint-Induced Movement Therapy with that of Bimanual Intensive Training in Children with Hemiplegic Cerebral Palsy

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Abstract
The aim of this study was to compare the effects of modified constraint-induced movement therapy (mCIMT; restraint of unaffected limb combined with unimanual intensive rehabilitation) with those of a bimanual intensive rehabilitation treatment (IRP) in children with hemiplegic cerebral palsy after a 10-wk practice vs. standard treatment (ST). This study is a multicenter, cluster-randomized controlled clinical trial of tested groups of children with hemiplegic cerebral palsy treated using mCIMT, IRP, or ST. For 10 wks, in mCIMT and IRP, the intensive practice lasted 3 hrs/day, 7 days/wk; in ST, 1-hr sessions twice a week were provided. The primary outcomes are upper limb/hand function (Quality of Upper Extremity Skills Test) and activities of daily living (Besta Scale), which are assessed before and after treatment. One hundred five patients were recruited, 39 to the mCIMT group, 33 to the IRP group, and 33 to the ST group. IRP and mCIMT significantly improved paretic hand function both in the Quality of Upper Extremity Skills Test and in the Besta Scale, whereas ST did not. mCIMT improved grasp more than IRP did (P < 0.01), whereas bimanual spontaneous use in play increased more with IRP (P = 0.0005). Activities of daily living in 2- to 6-yr-olds improved more with IRP (P < 0.0001) than with mCIMT (P = 0.011). Unaffected limb improved more from bimanual practice (IRP; P = 0.02). More advantages resulted from intensive practice than in the standard one, in mCIMT for grasp and in IRP for bimanual spontaneous use and activities of daily living in younger children.

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