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Impact of intensive upper limb rehabilitation on quality of life: a randomized trial in children with unilateral cerebral palsy
Author(s) -
SAKZEWSKI LEANNE,
CARLON STACEY,
SHIELDS NORA,
ZIVIANI JENNY,
WARE ROBERT S,
BOYD ROSLYN N
Publication year - 2012
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/j.1469-8749.2012.04272.x
Subject(s) - cerebral palsy , physical therapy , quality of life (healthcare) , constraint induced movement therapy , spasticity , randomized controlled trial , medicine , rehabilitation , international classification of functioning, disability and health , psychology , physical medicine and rehabilitation , pediatrics , surgery , nursing
Aim The aim of this study was to determine whether constraint‐induced movement therapy is more effective than bimanual training in improving the quality of life of children with unilateral cerebral palsy (CP). Method Sixty‐three children (mean age 10y 2mo [SD 2y 6mo]; 33 males, 30 females) with CP of the spastic motor type ( n =59) or with spasticity and dystonia ( n =4) were randomly allocated to two groups. The children were assessed as Manual Ability Classification System level I ( n =16), II ( n =46), or III ( n =1). Each group received 6 hours of daily intervention (either constraint‐induced movement therapy [CIMT] or bimanual training [BIM]) for 10 days over a 2‐week period (total intervention time 60h). Children aged 9 years and older completed the Cerebral Palsy Quality of Life Questionnaire for Children (CPQOL‐Child) and those aged 8 years and older completed the KIDSCREEN‐52. All parents completed proxy versions of each measure. Assessments were made at baseline and at 3, 26, and 52 weeks after the end of the intervention. Results Thirty‐five children completed the CPQOL‐Child and 41 completed the KIDSCREEN‐52. No changes in social or emotional well‐being were reported by children in either group. Children and parents from both groups reported a significant improvement in their or their child’s feelings about functioning as well as participation and physical health on the CPQOL‐Child. The parents of children receiving CIMT reported positive and sustained changes in their child’s social well‐being (CPQOL‐Child). The CIMT group showed significant improvements in physical well‐being, psychological well‐being, and moods and emotions (KIDSCREEN‐52) at 3 weeks post intervention, which were maintained over the study period. Interpretation Intensive goal‐directed upper limb training programmes using either CIMT or BIM achieved domain‐specific changes in quality of life relating to feelings about functioning and participation and physical health. A condition‐specific quality of life compared with a generic measure may be better able to detect changes in quality of life in children with unilateral CP.