EFFECTS OF CLASSIC CONSTRAINT INDUCED MOVEMENT THERAPY AND ITS MODIFIED FORM ON QUALITY OF LIFE OF CHILDREN WITH HEMIPLEGIC CEREBRAL PALSY

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Mamoona Tasleem Afzal
Nisar Fatima
Samiya Asghar
Abdul Maajid Khokhar
Fareeha Kausar
Azka Kainat
Mubara rehman
Mian Waleed Ahmed
Ayesha Javed
Dr. Tamjeed Ghaffar

Keywords

Constraint induced movement therapy, Cerebral palsy, CPQOL, QUEST

Abstract

Objective: To see the effects of classic constraint induced movement therapy (CCIMT) and its modified form (MCIMT) on quality of life of children with hemiplegic cerebral palsy (HCP).


Methods: A RCT was conducted in NIRM hospital, Islamabad. Children (n=40) with hemiplegic CP were randomly allocated in CCIMT and MCIMT. 4-12 years old children with ipsilateral, bilateral or severely asymmetrical impairment having wrist extension (20°) and fingers flexion (10°) were included. CCIMT group received 6 hrs of daily task training of affected hand, five days a week for 3 weeks. MCIMT group received same protocol as CCIMT group for 2 weeks, but MCIMT group received 2 hrs of daily task training involving both hands, 5 days a week, for 1 week. The outcomes tools, CP (Quality Of Life) and Kid screen were used at baseline, mid and post treatment assessment. 


Results: Both treatment approaches equally improved psychosocial life of children with HCP. On CPQOL tool, two domains (participation & physical health and Family health) showed significant difference (p vale=0.042 and p value=0.025 respectively) favouring the CCIMT. But there was no significant difference was found regarding other domains of tools.


Conclusion:  It concluded that both treatment approaches are effective to enhance the quality of life (psychosocial life) of children with HCP.

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References

1. Charles JR, Wolf SL, Schneider JA, Gordon AM. Efficacy of a child-friendly form of constraint-induced movement therapy in hemiplegic cerebral palsy: a randomized control trial. Developmental medicine and child neurology. 2006;48(8):635-42.
2. Gordon AM, Charles J, Wolf SL. Efficacy of constraint-induced movement therapy on involved upper-extremity use in children with hemiplegic cerebral palsy is not age-dependent. Pediatrics. 2006;117(3):e363-e73.
3. Charles J, Lavinder G, Gordon AM. Effects of constraint-induced therapy on hand function in children with hemiplegic cerebral palsy. Pediatric Physical Therapy. 2001;13(2):68-76.
4. Graham HK. Botulinum toxin A in cerebral palsy: functional outcomes. The Journal of pediatrics. 2000;137(3):300-3.
5. Naylor C, Bower E. Modified constraint‐induced movement therapy for young children with hemiplegic cerebral palsy: a pilot study. Developmental Medicine & Child Neurology. 2005;47(6):365-9.
6. Sutcliffe TL, Gaetz WC, Logan WJ, Cheyne DO, Fehlings DL. Cortical reorganization after modified constraint-induced movement therapy in pediatric hemiplegic cerebral palsy. Journal of child neurology. 2007;22(11):1281-7.
7. Choudhary A, Gulati S, Kabra M, Singh UP, Sankhyan N, Pandey RM, et al. Efficacy of modified constraint induced movement therapy in improving upper limb function in children with hemiplegic cerebral palsy: a randomized controlled trial. Brain and Development. 2013;35(9):870-6.
8. Morris D, Taub E, Mark V. Constraint-induced movement therapy: characterizing the intervention protocol. Europa medicophysica. 2006;42(3):257.
9. Sakzewski L, Ziviani J, Boyd RN. Efficacy of upper limb therapies for unilateral cerebral palsy: a meta-analysis. Pediatrics. 2014;133(1):e175-e204.
10. Eliasson AC, Krumlinde‐Sundholm L, Gordon AM, Feys H, Klingels K, Aarts PB, et al. Guidelines for future research in constraint‐induced movement therapy for children with unilateral cerebral palsy: an expert consensus. Developmental Medicine & Child Neurology. 2014;56(2):125-37.
11. Chen Y-p, Pope S, Tyler D, Warren GL. Effectiveness of constraint-induced movement therapy on upper-extremity function in children with cerebral palsy: a systematic review and meta-analysis of randomized controlled trials. Clinical rehabilitation. 2014;28(10):939-53.
12. Deppe W, Thuemmler K, Fleischer J, Berger C, Meyer S, Wiedemann B. Modified constraint-induced movement therapy versus intensive bimanual training for children with hemiplegia–a randomized controlled trial. Clinical rehabilitation. 2013;27(10):909-20.
13. Gordon AM, Hung Y-C, Brandao M, Ferre CL, Kuo H-C, Friel K, et al. Bimanual training and constraint-induced movement therapy in children with hemiplegic cerebral palsy: a randomized trial. Neurorehabilitation and neural repair. 2011;25(8):692-702.
14. Case-Smith J, DeLuca SC, Stevenson R, Ramey SL. Multicenter randomized controlled trial of pediatric constraint-induced movement therapy: 6-month follow-up. American Journal of Occupational Therapy. 2012;66(1):15-23.
15. Fonseca Junior PR, Filoni E, Setter CM, Berbel AM, Fernandes AO, Moura RCdF. Constraint-induced movement therapy of upper limb of children with cerebral palsy in clinical practice: systematic review of the literature. Fisioterapia e Pesquisa. 2017;24(3):334-46.
16. Zafer H, Amjad I, Malik AN, Shaukat E. Effectiveness of constraint induced movement therapy as compared to bimanual therapy in upper motor function outcome in child with hemiplegic cerebral palsy. Pakistan journal of medical sciences. 2016;32(1):181.
17. Desrosiers J, Bravo G, Hébert R, Dutil É, Mercier L. Validation of the Box and Block Test as a measure of dexterity of elderly people: reliability, validity, and norms studies. Archives of physical medicine and rehabilitation. 1994;75(7):751-5.
18. DeMatteo C, Law M, Russell D, Pollock N, Rosenbaum P, Walter S. The reliability and validity of the Quality of Upper Extremity Skills Test. Physical & Occupational Therapy in Pediatrics. 1993;13(2):1-18.
19. Atasavun Uysal S, Düger T, Elbasan B, Karabulut E, Toylan İ. Reliability and validity of the cerebral palsy quality of life questionnaire in the Turkish population. Perceptual and motor skills. 2016;122(1):150-64.
20. Nezu S, Iwasaka H, Saeki K, Obayashi K, Ishizuka R, Goma H, et al. Reliability and validity of Japanese versions of KIDSCREEN-27 and KIDSCREEN-10 questionnaires. Environmental health and preventive medicine. 2016;21(3):154.
21. Dong VA-Q, Tung IH-H, Siu HW-Y, Fong KN-K. Studies comparing the efficacy of constraint-induced movement therapy and bimanual training in children with unilateral cerebral palsy: a systematic review. Developmental neurorehabilitation. 2013;16(2):133-43.
22. Sakzewski L, Miller L, Ziviani J, Abbott DF, Rose S, Macdonell RA, et al. Randomized comparison trial of density and context of upper limb intensive group versus individualized occupational therapy for children with unilateral cerebral palsy. Developmental Medicine & Child Neurology. 2015;57(6):539-47.
23. de Brito Brandão M, Mancini MC, Vaz DV, Pereira de Melo AP, Fonseca ST. Adapted version of constraint-induced movement therapy promotes functioning in children with cerebral palsy: a randomized controlled trial. Clinical rehabilitation. 2010;24(7):639-47.
24. Hoare BJ, Wasiak J, Imms C, Carey L. Constraint‐induced movement therapy in the treatment of the upper limb in children with hemiplegic cerebral palsy. Cochrane Database of Systematic Reviews. 2007(2).
25. Taub E, Ramey SL, DeLuca S, Echols K. Efficacy of constraint-induced movement therapy for children with cerebral palsy with asymmetric motor impairment. Pediatrics. 2004;113(2):305-12.