Constraint induced movement therapy in cerebral palsy
Cerebral palsy is a non-progressive neurological condition resulting in motor impairments that can change over time. In about one-third of children with cerebral palsy, one side of the body is affected much more than the other. The impairments may originate directly from damage to an immature brain, or indirectly from compensatory movements or disuse during development. The disuse of the more affected arm is a natural consequence of children wanting to manipulate objects and therefore preferentially using the less affected arm in daily life. However, this means that much of the impairment of the more affected arm could be a form of "learned disuse", rather than from the initial damage to the brain.
Many studies have been conducted to investigate whether constraining (literally, tying down) the less affected arm can help to improve the function of the more affected arm. It can be difficult to gauge whether this intervention (known as Constraint Induced Movement Therapy, or CIMT) is effective for children who have one side of the body much more affected by cerebral palsy. The difficulty arises not from a lack of research - but from the existence of many trials with occasionally conflicting results.
Now physiotherapy researchers have tackled this, by first identifying the available studies that examine CIMT versus no therapy. These show that CIMT does improve arm function and use in these children. However, the researchers then went back to the literature and identified all the studies that compared CIMT to the same amount of rehabilitation of the more affected arm, but where the good arm was not tied down. Interestingly, the amount of improvement was the same in both groups in these latter trials. This suggests that CIMT works by enforcing rehab time for the arm, but if the patient can be engaged in the same amount of arm rehab without constraint of the good arm, the same amount of benefit can still be expected.
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> From: Chiu et al., J Physiother 62 (2016) 130-137. All rights reserved to the Australian Physiotherapy Association. Click here for the Pubmed summary.