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American Academy of Pediatrics
Article

Efficacy of Constraint-Induced Movement Therapy for Children With Cerebral Palsy With Asymmetric Motor Impairment

Edward Taub, Sharon Landesman Ramey, Stephanie DeLuca and Karen Echols
Pediatrics February 2004, 113 (2) 305-312; DOI: https://doi.org/10.1542/peds.113.2.305
Edward Taub
*Department of Psychology
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Sharon Landesman Ramey
‡Civitan International Research Center, University of Alabama, Birmingham, Alabama
§Center for Health and Education, Georgetown University, Washington, District of Columbia
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Stephanie DeLuca
*Department of Psychology
‡Civitan International Research Center, University of Alabama, Birmingham, Alabama
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Karen Echols
‡Civitan International Research Center, University of Alabama, Birmingham, Alabama
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Abstract

Objective. Constraint-Induced Movement (CI) therapy has been found to be a promising treatment for substantially increasing the use of extremities affected by such neurologic injuries as stroke and traumatic brain injury in adults. The purpose of this study was to determine the applicability of this intervention to young children with cerebral palsy.

Methods. A randomized, controlled clinical trial of pediatric CI therapy in which 18 children with diagnosed hemiparesis associated with cerebral palsy (7–96 months old) were randomly assigned to receive either pediatric CI therapy or conventional treatment. Pediatric CI therapy involved promoting increased use of the more-affected arm and hand by intensive training (using shaping) of the more-impaired upper extremity for 6 hours/day for 21 consecutive days coupled with bivalved casting of the child’s less-affected upper extremity for that period. Children’s functional upper-extremity skills were assessed in the laboratory (blinded scoring) and at home (parent ratings) just prior, after, and 3 weeks posttreatment. Treated children were followed for 6 months.

Results. Children receiving pediatric CI therapy compared with controls acquired significantly more new classes of motoric skills (9.3 vs 2.2); demonstrated significant gains in the mean amount (2.1 vs 0.1) and quality (1.7 vs 0.3) of more-affected arm use at home; and in a laboratory motor function test displayed substantial improvement including increases in unprompted use of the more-affected upper extremity (52.1% vs 2.1% of items). Benefits were maintained over 6 months, with supplemental evidence of quality-of-life changes for many children.

Conclusion. Pediatric CI therapy produced major and sustained improvement in motoric function in the young children with hemiparesis in the study.

  • hemiparesis
  • cerebral palsy
  • pediatric rehabilitation
  • pediatric CI therapy
  • learned nonuse
  • upper extremity
  • CI therapy
  • Received August 29, 2002.
  • Accepted May 28, 2003.
  • Copyright © 2004 by the American Academy of Pediatrics

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Pediatrics
Vol. 113, Issue 2
1 Feb 2004
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Efficacy of Constraint-Induced Movement Therapy for Children With Cerebral Palsy With Asymmetric Motor Impairment
Edward Taub, Sharon Landesman Ramey, Stephanie DeLuca, Karen Echols
Pediatrics Feb 2004, 113 (2) 305-312; DOI: 10.1542/peds.113.2.305

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Efficacy of Constraint-Induced Movement Therapy for Children With Cerebral Palsy With Asymmetric Motor Impairment
Edward Taub, Sharon Landesman Ramey, Stephanie DeLuca, Karen Echols
Pediatrics Feb 2004, 113 (2) 305-312; DOI: 10.1542/peds.113.2.305
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  • Article
    • Abstract
    • METHODS
    • RESULTS
    • DISCUSSION
    • APPENDIX I: PMAL
    • APPENDIX II: CHILD ARM USE TEST
    • GLUE BOYS
    • Acknowledgments
    • Footnotes
    • REFERENCES
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  • Early childhood constraint therapy for sensory/motor impairment in cerebral palsy: a randomised clinical trial protocol
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  • Efficacy of Upper Limb Therapies for Unilateral Cerebral Palsy: A Meta-analysis
  • Importance for CP Rehabilitation of Transfer of Motor Improvement to Everyday Life
  • Enriched Environments and Motor Outcomes in Cerebral Palsy: Systematic Review and Meta-analysis
  • Structural Neuroplastic Change After Constraint-Induced Movement Therapy in Children With Cerebral Palsy
  • Bound for Success: A Systematic Review of Constraint-Induced Movement Therapy in Children With Cerebral Palsy Supports Improved Arm and Hand Use
  • Invited Commentary
  • Systematic Review and Meta-analysis of Therapeutic Management of Upper-Limb Dysfunction in Children With Congenital Hemiplegia
  • Management of Stroke in Infants and Children: A Scientific Statement From a Special Writing Group of the American Heart Association Stroke Council and the Council on Cardiovascular Disease in the Young
  • Use of Virtual Reality to Improve Upper-Extremity Control in Children With Cerebral Palsy: A Single-Subject Design
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  • Is there evidence to support the use of constraint-induced therapy to improve the quality or quantity of upper extremity function of a 2 1/2-year-old girl with congenital hemiparesis? If so, what are the optimal parameters of this intervention?
  • Efficacy of Constraint-Induced Movement Therapy on Involved Upper-Extremity Use in Children With Hemiplegic Cerebral Palsy Is Not Age-Dependent
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Subjects

  • Neurology
    • Neurology

Keywords

  • hemiparesis
  • cerebral palsy
  • pediatric rehabilitation
  • pediatric CI therapy
  • learned nonuse
  • upper extremity
  • CI therapy
  • CP, cerebral palsy
  • PT, physical therapy
  • OT, occupational therapy
  • CI, Constraint-Induced Movement
  • EIP, early-intervention program
  • EBS, Emerging Behaviors Scale
  • PMAL, Pediatric Motor Activity Log
  • TAUT, Toddler Arm Use Test
  • DASI-II, Developmental Activities Screening Inventory
  • ANCOVA, analysis of covariance
  • df, degrees of freedom
  • SD, standard deviation
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