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Constraint‐induced movement therapy for children with neonatal brachial plexus palsy: a randomized crossover trial
Author(s) -
Werner Julie M,
Berggren Jamie,
Loiselle Jennifer,
Lee Gina Kim
Publication year - 2021
Publication title -
developmental medicine and child neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.658
H-Index - 143
eISSN - 1469-8749
pISSN - 0012-1622
DOI - 10.1111/dmcn.14741
Subject(s) - medicine , constraint induced movement therapy , physical therapy , randomized controlled trial , crossover study , psychological intervention , brachial plexus , physical medicine and rehabilitation , quality of life (healthcare) , rehabilitation , surgery , placebo , alternative medicine , pathology , nursing , psychiatry
Aim To determine if constraint‐induced movement therapy (CIMT) is more effective than standard care in improving upper‐limb activity outcomes in children with neonatal brachial plexus palsy (NBPP). Method Twenty‐one children with NBPP (mean age 25mo, SD=10.3, range=17–48mo; 11 males, 10 females) were enrolled in a crossover trial and randomly allocated to first receive CIMT or standard care, each for 8 weeks. The intervention arm consisted of 3 weeks of casting the unaffected limb followed by 5 weeks of transference activities. The Assisting Hand Assessment (AHA) was used to measure bimanual activity performance at baseline, 8 weeks, and 16 weeks, scored by blinded raters. The Pediatric Motor Activity Log‐Revised (PMAL‐R) was used as a caregiver‐reported secondary outcome measure. Results After concealed random allocation ( n =21), there were no significant differences on demographics or baseline measures. CIMT was superior compared to control in terms of bimanual activity performance with a mean difference in AHA change score of 4.8 (SD=10.5, p =0.04, Cohen’s δ =0.46). There were no significant differences between treatment conditions on the PMAL‐R. Interpretation CIMT is favored over standard care for bimanual activity performance. Future research should investigate a longer follow‐up period, additional comparator interventions, and analyse differences by participant characteristics. What this paper adds Gains in bimanual activity performance were greater after constraint‐induced movement therapy (CIMT) compared to no CIMT. Frequency and quality of movement were not significantly different between treatment groups.