Marina de Brito Brandão, Andrew M. Gordon, Marisa Cotta Mancini; Functional Impact of Constraint Therapy and Bimanual Training in Children With Cerebral Palsy: A Randomized Controlled Trial. Am J Occup Ther 2012;66(6):672-681. doi: 10.5014/ajot.2012.004622.
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© 2017 American Occupational Therapy Association
OBJECTIVE. We compared children’s self-care performance and caregivers’ perception of children’s performance on functional goals established for children with hemiplegic cerebral palsy (CP) after unimanual constraint-induced movement therapy (CIMT) or hand–arm bimanual intensive training (HABIT).
METHOD. Sixteen children with CP were randomized to the CIMT or HABIT group. Interventions lasted for 15 days, 6 hr/day, totaling 90 hr. We used the Pediatric Evaluation of Disability Inventory and the Canadian Occupational Performance Measure (COPM) to assess the children’s daily functioning and mixed analyses of variance to compare group means on functional test scores before and after intervention.
RESULTS. Both groups showed significant improvements on functional measures. Group × Assessment interaction in COPM performance revealed greater improvements for the HABIT group after intervention (p = .04).
CONCLUSION. The results suggest that specificity of training exists only for performance of specific goals established by parents and that both CIMT and HABIT can be used to increase children’s daily functioning.
Does CIMT or HABIT lead to improvement in daily functioning outcomes?
Are changes in functional outcomes different after the two intervention protocols?
Do caregivers perceive that the children achieve functional goals as a result of these two intervention protocols?
Both CIMT and HABIT interventions had a positive impact on the functional self-care skills and independence of children with hemiplegic CP.
Children submitted to the HABIT protocol showed greater functional goal performance than children who received the CIMT intervention.
The opportunity to practice bimanual functional activities (i.e., HABIT) fosters changes in the daily living activities considered relevant by parents of children with CP.
Occupational therapists’ choice of CIMT or HABIT may rely on their own expertise, the child’s needs and interests, and characteristics of established client goals; the chosen protocol should include opportunity to practice goals that the child and caregiver deem important.
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