Constraints - Body Structure & Function

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 on all outcome measures 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 mCIMT within a virtual environment on upper limb function in children with cerebral palsy. Subjects were randomized into one of four groups: mCIMT, 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 systematic review (Hoare et al, 2007) including three studies found a significant treatment effect using mCIMT in a single non-randomized trial. A positive trend favouring CIMT and forced use was also demonstrated. The authors concluded that given the limited evidence, the use of CIMT should be considered experimental in children with hemiplegic cerebral palsy. Further research using adequately powered RCTs, rigorous methodology and valid, reliable outcome measures is essential.

Conclusion: There is strong evidence (level 1a) from two high quality RCTs indicating that CIMT improves quality of movement in the upper extremity. However, additional research is needed in order to set standardized parameters for such interventions.

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 range of motion post treatment, with the combination group demonstrating the most important gain.

Conclusion: There is moderate evidence (level 1b) from a single high quality RCT indicating that CIMT improves upper extremity active range of motion. However, additional research is required to demonstrate whether these gains are more clinically important in the CIMT group as compared to other interventions and whether these gains are maintained in the long-term.

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 to upper extremity spasticity were neither clinically important nor statistically significant.

Conclusion: There is moderate evidence (level 1a) from one high quality RCT that CIMT is not more effective than conventional occupational therapy in decreasing upper extremity spasticity in children with cerebral palsy.

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 grip strength post treatment, with the combination group demonstrating the most important gain.

Conclusion: There is moderate evidence (level 1b) from a single high quality RCT indicating that CIMT improves grip strength. However, additional research is required to demonstrate whether these gains are more clinically important in the CIMT group as compared to other interventions and whether these gains are maintained in the long-term.