TABLE 2

Structure and Content of Nonsurgical UL Intervention Programs for Children With Congenital Hemiplegia

StudyContent of Intervention ProgramDuration, wkFrequency of SessionsIntensityHome ProgramContent of Control GroupDuration, wkFrequency of SessionsIntensityHome Program
NDT
 Law et al (a)12Intensive NDT: bivalved cast262/wk0.75 h0.5 h/dIntensive NDT only262/wk0.75 h0.5 h/d
7/wk4 h
 Law et al (b)12Regular NDT: bivalved cast261/wk (maximum) to 1/mo (minimum)0.75 h0.25 h/d (3 d/wk)Regular NDT only261/wk (maximum) to 1/mo (minimum)0.75 h0.25 h (3d/wk)
4 h/d
 Law et al (a)13NDT: bivalved cast162/wk (minimum)0.75 h0.5 h/dRegular OT-functional skills161/wk (maximum) to 1/mo (minimum)0.75 hPrevious therapy
4 h/d
 Law et al (b)13NDT and casting second16a/aa/aa/aRegular OT (a/a)16a/aa/aa/a
BoNT-A
 Fehlings et al14Botox injections: dose, 2–6 U/kg; therapy: strength, ADLs260.5/wkNRNROT (as per intervention group)260.5/wkNRNR
 Speth et al15Botox injections: dilution, 5 U/0.1 mL; maximum dose, 400 U/kg; OT: strength, functional training, orthoses263/wk each OT and PTOT: 0.5 hNROT (as per intervention group)263/wkOT–0.5 hNR
PT: 0.5 hPT–0.5 h
 Lowe et al16Botox injections: dilution, 100 U/0.5 mL; maximum dose, <8 U/kg; total dose, 82–220 U; therapy: goal-directed, splint, strength26OT NRNRReported without detailOT (as per intervention group)26NRNRReported without detail
 Kawamura et al17Low-dose Botox injections: dilution, 100 U/1.0 to 2.0 mL; therapy: community-based, goal-directed, strength, fine motor, and ADLs120.7/wkNR6 wk (reported without detail)High-dose Botox injections: dilution 100 U/0.5–1.0 mL; therapy: as per low-dose group120.5/wkNR5.3 wks (reported without detail)
 Wallen et al (a)18Botox injections: dose, 0.5–2 U/kg; maximum dose, 12 U/kg: regular therapy26Maintained previous levelMaintained previous levelNRControl group26Maintained previous levelNR
 Wallen et al (b)18Botox injections: dose, 0.5–2 U/kg; maximum dose, 12 U/kg; therapy: stretch, cast, motor training, goal-directed121/wk1 hNROT as described for intervention group121/wk1 hNR
 Russo et al19Botox injections: dilution, 100 U/mL; maximum dose, <12 U/kg; total dose, 300 U; therapy: wt bearing, ball skills, strength, goal-directed41/wk1 hNROT as described for intervention group41/wk1 hNR
 Olesch et al20Botox injections: 3 series in 16-wk cycles; dilution, 100 U/mL; therapy: goal-directed6 each cycle2/wkNRProgram but no detail providedOT6 each cycle2/wkNRProgram but no detail provided
 Kanellopoulos et al21Botox injections: therapy, detail not reported; themoplastic night splint263/wkNRNRBotox injections and OT263/wkNRNR
 Rameckers et al24Botox injections: dilution, 5 U/0.1 mL; maximum dose, 400 U; OT/PT: strength, task-specific training; night splint; daytime wrist splint for children Zancolli IIB263/wk0.5 h OTNRPT/OT: strength, task-specific training; night splint; daytime wrist splint for children Zancolli IIB263/wk0.5 h OTNR
0.5 h PT0.5 h PT
 Pieber et al22Botox injections: maximum dose, 12 U/kg; total dose, 300 U; FES: 30 Hz, 0.2-ms pulse width, 2–5 s on time, 2–5 s off time; night splint61/wk (OT/PT)0.5 h OT0.5 h (FES) 5 times/wkBotox injections and OT, night splint61/wk0.5 h OTNR
0.5 h PT0.5 h PT
 Elvrum et al23Botox injections: dilution, 100 U/mL; resistance training, core strengthening, single joint 3 sets of 10 repetitions, progressive increase of 0.25–0.5 kg83/wk0.8 hNRBotox injections8NRNRNR
cCIMT
 Taub et al6 and Deluca et al25Restraint: long arm bivalve cast; context: individual clinic-based; training: repetitive task practice, shaping reach, grasp, wt bearing, manipulate, ADLs37/wk6 hNRStandard OT/PT31 session/wk (minimum) to 4 sessions/wk (maximum)2.2 h/wk (mean)NR
 Taub et al26Restraint: long arm cast; 13 d cCIMT, 2 d BIM; context: home-based; training: repetitive task practice, shaping in play, and ADLs2.17/wk6 hNRUsual care2.11/wk1–2 hNR
 Case-Smith et al27 and DeLuca et al28Restraint: full arm cast; training: 18 d cCIMT, 3 d BIM35/wk6 hNRCIMT: Restraint: full arm cast; training: 18 d CIMT, 3 d BIM35/wk3 hNR
mCIMT
 Charles et al7Restraint: sling; context: clinic-based groups of 2 to 4; training: movement training, play, functional therapy25/wk6 h1 h/d for CIMT 2 h/d (for 6 mo post CIMTMaintained previous levels2NRNRNR
 Smania et al29Restraint: mitt; context: individual; training: repetitive practice, play52/wk1 hMitt worn 8 h/dPT52/wk1 hNR
 Al Oraibi et al30Restraint: glove; context: home- and center-based; training: fine motor tasks81/wkNR2 h/d, 6 d/wkNDT: wt bearing, facilitation arm movement; context: home81/wk1–2 hNR
 Lin et al31Restraint: elastic bandage; context: home; training: repetitive task practice42/wk4 h4 h/dTherapy, functional activities, NDT, motor learning; context, home42/wk4 h4 h/d
 Sakzewski et al32,33Restraint: mitt;
context: community groups of 8 to13; training: repetitive task practice, circus themed25/wk6 hNilBIM; context, community groups of 8–13; training, repetitive bimanual activities25/wk6 hNil
 Wallen et al37Restraint: mitt; context: home, school, preschool; training: goal-directed, ADLs, repetitive movements in play81/wk1 h2 h/d, 7 d/wkOT: goal-directed, stretch, splint, motor training, environmental modification81/wk1 h0.3 h/d
 Gordon et al58 and de Brito Brandão et al36Restraint: sling; context: day camps, groups of 2 to 5; training: unimanual functional, and play35/wk6 h1 h/d for 6 moBIM: goal-directed, symmetrical and asymmetric35/wk6 h1 h/d for 6 mo
 Eliasson et al (a)40Eco-CIMT first Restraint: glove; context: individual home- or community- based; training: based on AHA assessment, repetitive whole-task practice87/wk2 h with weekly supervision by therapistUsual care: ADLs, fine motor training, functional activity-based81/m OTNRNR
 Eliasson et al (b)40Eco-CIMT second87/wk2 h as aboveUsual care: a/a82/m PTNRNR
1/m OT
2/m PT
 Facchin et al (c)38 and Fedrizzi et al39Restraint: glove; context: individual; training: holding, manipulation, ADLs103/wk3 h3 h/d for 4 dBIM103/wk3 h3 h/d for 4 d
 Facchin et al (c)38 and Fedrizzi et al39Restraint: glove; context: individual; training: a/a103/wk3 h3 h/d for 4 dUsual care101-2/wk1 hNR
 Facchin et al (c)38 and Fedrizzi et al39BIM; bimanual holding, manipulation, ADLs103/wk3 h3 h/d for 4 dUsual care101-2/wk1 hNR
 Xu et al (a)41Restraint: splint; context: hospital in groups of 2 to 4; training: structured play and functional activities; FES: 50 Hz pulse rate, 30 pulse/s, 300 μs amplitude, 12 s on time, 12 s off time25/wk3 h (mCIMT); 0.3 h (FES)1 h/d with restraint during CIMT 2 h/d for 6 mo after CIMTCIMT as per treatment group, no FES25/wk3 h1 h/d with restraint during CIMT, 2 h/d for 6 mo after CIMT
 Xu et al (b)41Restraint: splint; context: hospital in groups of 2 to 4; training, structured play and functional activities25/wk3 hOT: NDT, task-specific training, strength, stretch25/wk3 hTime not specified
 Hsin et al42 and Chen et al43Restraint: elastic bandage and glove; context: home; training: shaping and repetitive task practice42/wk3.5–4 h3.5–4 h/d for 3 d/wkTraditional rehab: NDT, task training; context: home42/wk3.5-4 hTime not specified
 Rostami et al (a)44Restraint: splint; context: home-based individual; training: reach, grasp, manipulate, fine motor, ADLs33/wk1.5 h1 h/dmCIMT Restraint: splint; context: clinic-based; training as per intervention group33/wk1.5 h1 h/d
 Rostami et al (b)45mCIMT: details a/a43/wk1.5 h5 h/d restraintCIMT and VR: E-Link Evaluation and Exercise System: active, active resistive grip and pinch, ROM exercises43/wk1.5 hNR
 Rostami et al (c)45mCIMT: details a/a43/wk1.5 h5 h/d restraintControl group: NDT, stretching, ROM41/wk1 hNR
 Choudhary et al46Restraint: arm sling; context: groups of 4; training: repetitive task practice, shaping42–3/wk2 h1 h/d (10 d) 2 h/d (30 d)Regular therapy: stretch, strength, bilateral hand tasks provided by parents at home45/wk20
 Hoare et al47Botox injections: maximum dose, 15 U/kg; dilution, 100 U/mL; therapy, mCIMT; restraint, glove; context: individual, hospital- based, and home82/wk1 hGlove and home practiceBotox injections and bimanual OT: motor learning and cognitive-based; context: individual hospital-based82/wk1 hTime not specified
21 h/wk
Hybrid model: combined mCIMT and bimanual training
 de Brito Brandão et al9Hybrid2 mCIMT5/wk4 hRestraint worn 10 h/d for 2 wkUsual care, bimanual activities, sensory stimulation31/wk0.75 hNR
Restraint: resting splint and sling; context, individual; training, shaping of fine motor, ADLs1 BIM3/wk0.75 h
 Aarts et al8mCIMT-BIT6 mCIMT3/wk3 hExpected duration NRUsual care: stretch, wt bearing, bimanual therapy82/wk1.5 h1 h/d
Restraint: sling; context: rehab center in groups of 6; training: mCIMT 6 wk repetitive task practice, BIM 2 wk, goal-directed2 BIM
Forced-use therapy
 Sung et al48Forced-use therapy62/wk0.5 hNROT as per intervention group62/wk0.5 hNR
Restraint: short arm cast; therapy: stretch, reach, grasp, manipulate, functional training
 Eugster-Buesch et al49Restraint: removable cast; regular therapy27/wk6 hADLsControl group21/wkNRNR
1/wkNR2 h/d
Other UL interventions
 Gordon et al50HABIT; context: groups of 4; training: bilateral fine motor, manipulative gross motor activities25/wk6 h1 h/dMaintained previous levels2NRNRNR
2 h/d post treatment of 1 mo
 Novak et al (a)51OT home program: goal-directed, parent education, handwriting, strength, play80.6/wk0.25 h/session (mean)Control group8NRNRNR
 Novak et al (b)51OT home program: details as above40.6/wk0.25 h/session (mean)Control group8NRNRNR
 Elliott et al52Second skin lycra splint, goal-directed training embedded in daily routine125/wk6 h (splint)0.4 h (training)Goal-directed training125/wk0.4 h
 Law et al53Child-focused260.7–0.9/wkNRNRContext-focused: goal-directed, task and environment adaptation260.7 to 0.9/wkNRNR
Remediation of impairments using stretch, cast, strength, wt bearing, and facilitation of normal movement
 Gygax et al (a)54Mirror therapy and bimanual activities first: bilateral thumb-fingers pinch and grasp and pronation supination; context: home37/wk0.25 hBimanual activities as per treatment group, no mirror; context: home37/wk0.25 h
 Gygax et al (b)54Mirror therapy and bimanual activities second37/wk0.25 ha/a37/wk0.25 h
 Duncan et al55Acupuncture: massage, scalp and body acupuncture; therapy: OT, fine motor tasks, ADLs; hydro35/wk0.5 h OTTherapy: OT, fine motor, ADLs; hydro35/wk0.5 h OT
0.5 h PT0.5 h PT
0.5 h hydro0.5 h hydro
 Buccino et al56Action observation and usual care35/wkNRNRSham video and usual care35/wkNRNR
 Rostami et al (d)45VR: E-Link Evaluation and Exercise System: active, active resistive grip and pinch, ROM exercises43/wk1.5 hNRControl group: NDT, stretching, ROM41/wk1 hNR
  • a/a, as above; ADLs, activities of daily living; BIM, bimanual; Eco, ecological; hydro, hydrotherapy; NR, not reported; PT, physiotherapy; rehab, rehabilitation; ROM, range of motion; VR, virtual reality; Zancolli IIB: no active wrist extension with fingers flexed.