High-Dose Constraint-Induced Movement Therapy Effective in Cerebral Palsy

By Lisa Rapaport

November 08, 2021

(Reuters Health) - Children with hemiparetic cerebral palsy can achieve better long-term improvements when they receive three hours of constraint-induced movement therapy five days a week for one month than with standard physical and occupational therapy, a randomized clinical trial found.

For the trial, researchers randomized 118 children ranging from 2 to 8 years old with hemiparetic cerebral palsy to one of four intervention groups: 30 or 60 hours of constraint-induced movement therapy (CIMT) combined with a cast or a splint. A control group received only usual care consisting of standard physical therapy and occupational therapy sessions. The lower dose of CIMT consisted of 2.5-hour sessions three days a week for one month.

At six months, children who received the higher dose of CIMT with either a cast or a splint had significantly greater improvements in a wide range of upper extremity skills such as moving, manipulating, and grasping objects and self-care activities than children in the control group, researchers report in Pediatrics.

Gains for children who received the lower dose of CIMT were similar to controls.

"Overall, children who received the higher CIMT dosage did better on multiple measures in terms of how they gained above their entry level skills and functioning," said lead study author Sharon Landesman Ramey, of the Fralin Biomedical Research Institute at the Virginia Polytechnic Institute and State University in Roanoke.

"We know of no parent or clinician who would not choose to realize similar positive outcomes compared to those detected in the other groups," Ramey said by email. "What was surprising - and comforting - is that the other treatments also showed benefits for the participating children."

One reason that children in the control group may have also experienced some improvements, albeit much more subtle than high-dose CIMT, is that they had more therapy than is traditionally delivered as part of standard care, the study team notes. Controls received four to five hours per week of physical and occupational therapy, which is more than double what some patients currently receive in clinical practice.

The study found children improved with high-dose CIMT based on both blinded assessor outcomes and parent-reported outcomes of functional skills in daily life.

Researchers had predicted that the higher dose would produce the best outcomes, largely because of findings in the field of developmental neuroscience that show more intensive learning and practice opportunities exert a greater effect on brain architecture and functioning as well as longer-term behavioral benefits, Ramey said.

But the study team wasn't certain what the threshold for a sufficient dosage of CIMT might be, Ramey noted.

"Our study still does not provide a definitive minimum dose - nor does this study show whether even greater benefits could accrue with larger dosages," Ramey said.

SOURCE: https://bit.ly/3BW4rC8 Pediatrics, online October 14, 2021.

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