Jane Case-Smith, Stephanie C. DeLuca, Richard Stevenson, Sharon Landesman Ramey; Multicenter Randomized Controlled Trial of Pediatric Constraint-Induced Movement Therapy: 6-Month Follow-Up. Am J Occup Ther 2012;66(1):15-23. doi: 10.5014/ajot.2012.002386.
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OBJECTIVE. Pediatric constraint-induced movement therapy (CIMT) is a promising intervention for children with unilateral cerebral palsy (CP). This multisite randomized controlled trial (RCT) tested the hypothesis that 6 hr versus 3 hr per day for 21 days would produce larger maintenance of gains 6 mo posttreatment.
METHOD. Three sites recruited 18 children (6 per site) ages 3–6 yr with unilateral CP. Children were randomly assigned to 3 or 6 hr/day of CIMT for 21 days and wore a cast on the unaffected extremity the first 18 days. Occupational therapists applied a standardized pediatric CIMT protocol. Evaluators blinded to condition administered the Assisted Hand Assessment and the Quality of Upper Extremity Skills Test, and parents completed the Pediatric Motor Activity Log pre- and posttreatment (1 wk, 1 mo, and 6 mo).
RESULTS. Both CIMT dosage groups showed significant gains on all five assessments with no significant group differences at 6-mo follow-up. Effect sizes (n = 15) comparing preintervention to postintervention measures (partial η2) ranged from .33 to .80.
CONCLUSION. This first multisite RCT of pediatric CIMT confirmed the maintenance of positive effects at 6 mo follow-up across multiple functional performance measures. The hypothesis that maintenance of effects would differ for children who received 6 versus 3 hr/day of CIMT (126 vs. 63 total hr) was not supported.
Children with unilateral CP who receive 3 hr/day or 6 hr/day of CIMT for 21 days will show significant improvements in functional use of their upper extremity at 6-mo follow-up.
Children with unilateral CP who receive 6 hr/day of CIMT versus 3 hr/day for 21 days will show greater gains (higher levels of maintenance) at 6-mo follow-up.
Specificity of learning by means of particular tasks in the natural environment that required specific upper-extremity movements
Blocked and random practice, with blocked practice used when a skill was first introduced and intermittent random practice after the skill was at least partially established
Extrinsic and immediate feedback to reinforce the child’s movement, improve motivation, and reduce error
Transfer of learning to encourage the child to use the new movement patterns in a variety of settings and tasks (O’Brien & Williams, 2010; Schmidt & Wrisberg, 2000).
CIMT is an intensive protocol that results in important gains in children’s upper-extremity function as assessed by parents and practitioners.
Key active ingredients appear to be the constraint of the unaffected arm, daily therapy sessions that focus on practice and challenges, immediate and specific reinforcement of performance, and transfer of learning into the child’s natural environment.
The children in our sample did not make significantly greater gains in performance with a 6 hr/day protocol than with a 3 hr/day protocol. Our results suggest that a 3 hr/day intervention is sufficient to achieve important effects and that >3 hr/day may not be more beneficial.
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