Article

OBJECTIVE: To determine the feasibility and short-term efficacy of
caregiver-directed constraint-induced movement therapy to improve upper limb
function in young children with hemiplegic cerebral palsy. DESIGN: Randomized
controlled trial with masked assessment. SETTING: Community paediatric therapy
services. SUBJECTS: Pre-school children with hemiplegic cerebral palsy.
INTERVENTIONS: Caregiver-directed constraint-induced movement therapy
administered using either 24-hour short-arm restraint device (prolonged) or
intermittent holding restraint during therapy (manual). MAIN MEASURES: Primary
measures include Assisting Hand Assessment (AHA) at 10 weeks. Secondary measures
include adverse events, Quality of Upper Extremity Skills Test and Pediatric
Quality of Life Inventory. Feasibility measures include recruitment, retention,
data completeness and adherence. RESULTS: About 62/81 (72%) of eligible patients
in 16 centres were randomized (prolonged restraint n = 30; manual restraint n =
32) with 97% retention at 10 weeks. The mean change at 10 weeks on the AHA
logit-based 0-100 unit was 9.0 (95% confidence interval (CI): 5.7, 12.4; P <
0.001) for prolonged restraint and 5.3 (95% CI: 1.3, 9.4; P = 0.01) for manual
restraint with a mean group difference of 3.7 (95% CI: -1.5, 8.8; P = 0.156) (AHA
smallest detectable difference = 5 units). No serious related adverse events were
reported. There were no differences in secondary outcomes. More daily therapy was
delivered with prolonged restraint (60 vs 30 minutes; P < 0.001). AHA data were
complete at baseline and 10 weeks. CONCLUSION: Caregiver-directed
constraint-induced movement therapy is feasible and associated with improvement
in upper limb function at 10 weeks. More therapy was delivered with prolonged
than with manual restraint, warranting further testing of this intervention in a
longer term trial.

Langue : ANGLAIS