[The Constraint-Induced Movement Therapy in children with hemiplegic cerebral palsy: post intervention results of an Italian multisite trial]

Objective. Constraint-Induced Movement Therapy (CIMT) has been proposed as a promising novel approach to improve the hand function in children with hemiplegia, but its efficacy is still object of a debate. In fact, it is still to be cleared up if the effect observed can be entirely attributed to CIMT itself rather than on the amount and quality of repetitive exercise. Therefore it is difficult to distinguish the effects of the constraint from those of intensive rehabilitation. The aim of this study is to measure the effect of CIMT on patients with hemiplegic CP immediately after the end treatment practice comparing three groups of patients (1° group mCIMT: Constraint of the non affected hand and unilateral intensive treatment of the affected hand 2° group: Intensive Rehabilitation Program (IRP) of bimanual training and 3° group: Standard Treatment of one or two weekly sessions of physiotherapy). This design choice allows us to distinguish the constraint’s effects from those of intensive rehabilitation, and assess the real effectiveness of hand restraint. Method. The study has been designed as a multicenter, prospective, cluster-randomized controlled clinical trial. Primary outcome measures concern UE motor ability (QUEST) and assessment of affected hand’s function in spontaneous use (Besta Scale). Before starting the controlled trial, a specific training program was provided to familiarize professionals (both principal investigator and therapist) with testing and training procedure in order to develop a homogeneous administration and videotaping of the QUEST and Besta Scale tests21. A specific training at the Rehabilitation Center and a dedicated booklet with a DVD were provided to parents of recruited children in order to standardize the activities at home during play and daily living. Results. 105 patients were recruited and assigned to the treatment groups CIMT (n = 39), bimanual IRP (n = 33) and Standard Treatment (n = 33). The changes are statistically significant in the global score before and after treatment of the 2 groups (CIMT and IRP group) of children assessed with the Besta Scales and QUEST. In CIMT group the improvement in grasp function is more relevant and statistically significant. In IRP group, the improvement is more significant in activities of spontaneous use and ADL. Conclusions. Our results demonstrate that a substantial improvement of paretic hand function was observed in children treated both with constraint of the unaffected hand and intensive unilateral practice and those treated with intensive bilateral practice without restriction. These data, if confirmed at the further followup evaluations, support the value of intensive treatment in the rehabilitation of children with hemiplegia.