Hand & arm use
A high level RCT (Case-Smith et al, 2012) evaluated the whether 6 hours of CIMT for a period of 3 weeks was better than 3 hours per day in maintaining gains in upper limb function 6 months post-treatment. Both groups showed significant gains in the Assisting Hand Assessment with no significant group differences at 6 months post treatment. These results indicate that a 3hour/day intervention is sufficient to achieve important effects in upper limb function for children with unilateral cerebral palsy.
A high level RCT (Rostamia et al, 2012) investigated the effects of implementing a modified constraint-induced movement therapy within a virtual environment on upper limb function in children with cerebral palsy. Subjects were randomized into one of four groups: constraint-induced movement therapy, virtual reality, combination and control. Significantly higher gains were observed in the combination therapy group for the amount of limb use at post-test. These gains were maintained at the 3-month follow-up assessment.
A high level RCT (Wallen et al, 2011) evaluated the effects of modified constraint-induced therapy on ADLs and upper limb outcomes in children with hemiplegic cerebral palsy as compared to conventional therapy. Between-group differences for outcomes related hand and arm use were neither clinically important nor statistically significant.
A high level RCT (Charles et al, 2006) examined the efficacy of CIMT, modified to be child friendly, in children with hemiplegic cerebral palsy. Children in the treatment group demonstrated improved movement efficiency of the involved upper limb even after 6-month follow-up (p<0.05). Caregivers reported significant increases in use of involved limb and quality of movement.
A high level RCT (Deluca et al, 2006) verified whether a pediatric constraint-induced therapy has an effect on upper limb function. It was found that pediatric constraint-induced therapy produced significantly greater gains in hand and arm use than conventional rehabilitation services (p>0.05).
A high level RCT (Eliasson et al, 2011) evaluate the effect of Eco-CIMT in young children with unilateral cerebral palsy. Statistically important differences were found post eco-CIMT as compared to the control period for hand and arm use.
A systematic review (Huang et al, 2009) concluded that CIMT may increase the use of affected upper extremities for children with hemiplegic cerebral palsy. Further research should include power calculations, more rigorous designs, and measures of potential impacts on the developing brain.
Conclusion: All RCTs demonstrate that some version of CIMT is effective in increasing hand and arm use, however, there is conflicting evidence (level 4) indicating that CIMT is more effective in improving arm and hand use in children with cerebral palsy as compared to conventional therapy.
Fine hand use
A high level RCT (Rostamia et al, 2012) investigated the effects of implementing a modified constraint-induced movement therapy within a virtual environment on upper limb function in children with cerebral palsy. Subjects were randomized into one of four groups: constraint-induced movement therapy, virtual reality, combination and control. Significantly higher gains were observed in the combination therapy group for speed and dexterity at post-test. These gains were maintained at the 3-month follow-up assessment.
A high level RCT (Xu et al, 2012) compared the efficacy of constraint therapy, constraint therapy plus electrical stimulation, and occupational therapy in the treatment of hand dysfunction in children with cerebral palsy. It was found that all three groups improved on fine motor and visual-motor skills post treatment, with the combination group demonstrating the most important gain.
A high level RCT (Charles et al, 2006) examined the efficacy of CIMT, modified to be child friendly, in children with hemiplegic cerebral palsy. Children in the treatment group demonstrated improved dexterity of the involved upper limb even after 6-month follow-up (p<0.05).
A high level RCT (Hsin et al, 2012) investigated the efficacy of home-based constraint-induced therapy on the functional performance of children with cerebral palsy. The constraint-induced therapy group improved more on the fine manual skills than the traditional rehabilitation group with a large effect at post treatment (P=.001) and at 3-month follow-up (P=.001).
Conclusion: There is strong (level 1a) evidence demonstrating that CIMT improves fine hand use in children with cerebral palsy. However, further research is required to demonstrate clinically important differences between CIMT and conventional therapy in improving fine hand use.
Self-care/Life skills
A high level RCT (Wallen et al, 2011) evaluated the effects of modified constraint-induced therapy on ADLs and upper limb outcomes in children with hemiplegic cerebral palsy as compared to conventional therapy. Between-group differences for outcomes related self-care and daily living skills were neither clinically important nor statistically significant.
Conclusion: There is moderate evidence (level 1b) from one high quality RCT demonstrating that mCIMT does not lead to a significant increase in self-care skills as compared to conventional therapy.
