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Effects of modified constraint-induced movement therapy in real-world arm use in young children with unilateral cerebral palsy: a single-blind randomized trial
Hwang Y-S, Kwon J-Y
Neuropediatrics 2020 Aug;51(4):259-266
clinical trial
5/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: No; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

OBJECTIVE: To determine whether modified constraint-induced movement therapy (mCIMT) with continuous restraint is feasible and effective in improving the use of the paretic arm in the real world among infants and toddlers with unilateral cerebral palsy (CP). DESIGN: Single-blind randomized controlled trial. SETTING: Tertiary hospital. PARTICIPANTS: Children aged 7 to 36 months with unilateral CP (N = 24; 16 boys, 8 girls). INTERVENTION: The experimental group received 2-hour clinic-based mCIMT sessions (5 days per week for 3 weeks), and a continuous restraint was applied. MAIN OUTCOME MEASURES: Standardized assessments were conducted. Peabody Developmental Motor Scales-2 (PDMS-2), Gross Motor Function Measure-66, Pediatric Motor Activity Log (PMAL), and Pediatric Evaluation of Disability Inventory were measured pre- and postintervention. Children who agreed to participate in the accelerometer study additionally wore accelerometers on both their wrists for 3 days before and after the intervention. RESULTS: The mCIMT group exhibited greater improvement in PMAL-how often (p = 0.048; partial-eta2 = 0.173), PMAL-how well (p = 0.008; partial-eta2 = 0.289), and PDMS-2 visual motor integration (p = 0.014; partial-eta2 = 0.256) posttreatment than the control group. The percentage of time in moderate-to-vigorous physical activity (z = -2.24; p = 0.03) and vector magnitude average counts (z = -2.52; p = 0.01) significantly increased in children in who wore accelerometers (N = 8) after the 3-week mCIMT protocol. CONCLUSION: mCIMT with continuous restraint applied to infants and toddlers with unilateral CP appeared to have a positive effect on paretic hand use in the real world.

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