Children with hemiparetic cerebral palsy (HCP) treated with high-dose constraint-induced movement therapy (CIMT) had the largest improvements compared with other strategies, according to study findings published in Pediatrics.
For children with HCP, CIMT has been associated with improved arm-and-hand use, however, treatment protocols vary widely in dosage and constraint type. It’s not known whether lower CIMT doses and a splint rather than a cast could be more beneficial than usual customary treatment. The objective of the current study was to compare 2 doses and 2 constraint types of CIMT to usual customary treatment.
The Children with Hemiparesis Arm and Hand Movement Project (CHAMP) was a 2×2 factorial, randomized clinical trial conducted at 3 sites in the United States between 2015 and 2018 designed to better assess protocol best practices. Children (N=118) with HCP aged 2-8 years were randomized to receive usual care or high- or moderate-dose CIMT 5 times per week for 4 weeks with a cast or a splint. The high dose sessions lasted 60 total hours and the moderate dose, 30 hours. At baseline, week 4, and 6 months, patients were assessed by Assisting Hand Assessment (AHA), among other validated instruments.
The study population comprised of 63% girls who were aged mean 4.4 (standard deviation [SD], 2.1) years, they were mostly White (78%), and 55% were right affected.
At the end of treatment, an AHA improvement of ³5 points was observed among all groups. The high-dose CIMT with a cast had the highest gains of 7.0 (standard error [SE], 2.0) points at the end of treatment and 8.3 (SE, 2.0) points at 6 months. The lowest gains were observed for usual care (mean, 5.5; SE, 1.9 points) at end of treatment and high-dose CIMT with splint (mean, 5.5; SE, 1.9 points) at 6 months.
At the end of treatment, compared with the usual care cohort, high-dose CIMT had an AHA score that was 23.7% better, the moderate-dose 10.6%, cast 17.4%, and splint 17.0%. At 6 months, the scores were 6.2%, 4.7%, 15.0%, and -4.1% compared with control individuals, respectively.
Parents reported a modest decrease in their stress and less than 95% were favorable about their child’s adjustment to the cast and that both CIMT doses were acceptable.
A total of 4 adverse events were reported, none of which were treatment related.
This study had limited power as only 1 treatment group reached the intended size of 24 over the entire 6-month trial.
For children with HCP, 3-hour CIMT sessions with a cast delivered 5 days per week for 4 weeks consistently improved more function compared with usual care.
“In future analyses, researchers need to explore whether differential treatment benefits can be predicted more precisely by clinical and/or environmental variable,” the researchers concluded.
Ramey SL, DeLuca SC, Stevenson RD, Conaway M, Darragh AR, Lo W. Constraint-Induced Movement Therapy for Cerebral Palsy: A Randomized Trial. Pediatrics. Published online November 1, 2021. doi:10.1542/peds.2020-033878