Effectiveness Of Modified Constraint-Induced Movement Therapy Compared To Hand-Arm Bimanual Intensive Therapy On Quality Of Upper Extremity Function In Hemiplegic Cerebral Palsy Children - An Experimental Study

Background:Hemiplegic Cerebral palsy (CP) impairs hand function leading to inability or difficulty to perform activities of daily living (ADLs). Beside traditional therapies several new techniques like mCIMT & HABIT are in practice which focuses on precise and appropriate targeted results. There is a need to include a treatment protocol which is effective, easy and can be done under parents’ guidance in home setting. Purpose of this study was to find and compare the effect of mCIMT & HABIT on the quality of upper extremity function in children with hemiplegic cerebral palsy.Objectives:To study the effects of mCIMT, HABIT and conventional therapy on quality of upper extremity function in hemiplegic cerebral palsy children and to compare the effects of mCIMT, HABIT & conventional therapy on quality of upper extremity function in hemiplegic cerebral palsy children. Material & Methods:The study included 20 children who were diagnosed cases of hemiplegic CP. The experimental groups were given mCIMT and HABIT with conventional therapy and the control group received only conventional therapy.Quality of upper extremity skills test (QUEST) was used as an outcome measure. All groups were evaluated with the QUEST before and after 4 weeks of treatment. Results: The results showed statistical difference in the final QUEST scores(p=0.001) between all the groups as well as difference in dissociated movement, grasp & weight bearing. There was however no difference in protective extension (p=0.704) domain. Also, there was statistically no significant improvement in weight bearing and protective extension within the group while dissociated movement, grasp and QUEST Score showed improvement. Conclusion:This study concluded that mCIMT is more effective than HABIT & CT alone in improving quality of upper extremity function in hemiplegic cerebral palsy children.

Effect Of Proprioceptive Neuromuscular Facilitation On Selective Motor Control Of Lower Extremity In Children With Hemiplegic Cerebral Palsy: An Experimental Pilot Study

Background:Cerebral palsy children have limitations in motor function resulting in diminished selective motor control. Selective motor control (SMC) is essential for independent control of joint motion. Impaired SMC is interrelated to neuromuscular deficits in CP. In this study PNFapproach was used with different patterns and techniques which help to evoke motor responses and improve neuromuscular control and function.Objectives: To assess the effect of PNF along with conventional treatment ,To assess the effect of Conventional treatment and To compare the effect of PNF along with conventional treatment and conventional treatment on selective motor control of lower extremity in children with hemiplegic cerebral palsy. Material and Method:Study included 22 hemiplegic cerebral palsychildren which were divided into two groups. Experimental group received PNF and conventional treatment and control group received conventional treatment. SMC of lower extremity was assessed using SCALE. Pre and post treatment scores were measured.Results: There was statistically significant difference noted within group and between groups on Total SCALE score. Differencewas seen greater in experimental group than control group.Conclusion:This study suggests that PNF have an effect on selective motor control of lower extremity in children with hemiplegic cerebral palsy.

Efeitos de um protocolo modificado da terapia por contensão induzida em criança com paralisia cerebral hemiparética / Effects of a modified protocol of induced restraint therapy in children with hemiparetic brain paralysis

Avaliar os efeitos de um protocolo de intervenção modificado da Terapia por Contensão Induzida na qualidade do movimento e na frequência do uso da extremidade superior acometida em criança com paralisia cerebral hemiparética. Estudo longitudinal, de caso único, realizado com uma criançade quatro anos de idade submetida à intervenção por três horas diárias, durante dez dias, restrição da extremidade superior não acometida por oito horas diárias. Os dados foram coletados pela Pediatric Upper Extremity Motor Activity Log e analisados por meio de média aritmética. Observou-se melhora na qualidade do movimento e aumento da frequência do uso do membro superiorparético do período de pré para a pós-intervenção, mantendo-se o resultado consistente nas coletas de dados posteriores, além de aquisição de habilidades motoras funcionais. O protocolo de intervenção utilizado neste estudo foi eficaz no tratamento da criança com hemiparesia, os resultados podem ser úteis aos profissionais que trabalham com essa clientela, auxiliando-os no processo de intervenção.

Evaluate the effects of a modified ConstraintInduced Therapy intervention protocol regarding movement quality and frequency of use of the affected upper extremity on children with hemiplegic cerebral palsy. Longitudinal study of a single case, performed with a four year old submitted to intervention during three hours daily, for ten days, restricting thenon-affected upper extremity for eight hours daily. Data were collected using the Pediatric Upper Extremity Motor Activity Log and analyzed using the arithmetic mean. Significant improvement in quality of movement and frequency of use of the upper limbfrom pre to post-intervention were noted, maintaining the result in later data collection, besides the acquisition of functional motor skills. The modifi ed constraint-induced movement therapy protocol of this study was effective in treating the child with hemiplegiccerebral palsy, the results may be useful for professionals working with this clientele, assisting them in the intervention process.

Evaluation of body representation in children with hemiplegic cerebral palsy: toward the development of a neuropsychological test battery

Clinical observations indicate that many children with hemiplegic cerebral palsy (HCP) exhibit a lack of use or disregard of the affected upper limb. The aim of the present study was to develop, adapt, and verify the psychometric properties of a neuropsychological battery to assess body perception and representation disturbances in children with HCP. Three groups of children participated in this study, who took part in different phases of the validation process: one group of typically developing children (TD; n = 30; aged 4-6 years) and two groups of HCP children (HCP1: n = 12, aged 5-10 years; HCP2: n = 49, aged 5-13 years). Because no cognitive-neuropsychological model of body representation has been specifically developed for children, the tasks were designed based on a cognitive-neuropsychological model developed for adults. The chosen model comprises three levels of body representation: body schema, body structural description, and body image. The following steps were adopted in developing the instrument: development and choice of the tasks, selection and preparation of stimuli, adequacy and improvement of the instrument, semantic analysis of items, internal consistency, and feasibility and acceptability of application for TD and HCP children. The final set of tasks and items was chosen to balance the levels of difficulty and internal consistency. We concluded that the final battery was adequate and can be used to assess body representation disturbances in children with HCP...

Effects of the Constraint-Induced Movement Therapy on Cortical Reorganization in Patients with Hemiplegic Cerebral Palsy

OBJECTIVE: To investigate the effects of modified constraint- induced movement therapy (CIMT) on motor function and cortical activation in children with hemiplegic cerebral palsy (CP). METHOD: Five children with hemiplegic cerebral palsy were studied with Jebsen hand function test and quality of upper extremity skills test (QUEST), dynamic electromyography (EMG), and single photon emission computed tomography (SPECT) at rest before and after the CIMT period. Children were treated with a 4-week protocol of modified CIMT, consisting of twice-weekly 2-hour sessions of structured activities and a home program for non-treatment days. Children wore orthoses on their less affected upper extremities for 6 hours per day, during which time they were engaged in play, functional activities and 2-hour protocol of motor tasks. RESULTS: Improvements in upper-extremity function were found in Jebsen hand function test and QUEST. Increased muscle activities in elbow extensors were observed in dynamic EMG during affected hand grip. In right hemiplegic patients, regional cerebral perfusion increased in right Brodmann area (BA) 3 and lentiform nucleus. In left hemiplegic patients, regional cerebral perfusion increased in right BA 6, 9, 21, left BA 19 and left cerebellum, but decreased in left BA 11. CONCLUSION: Modified CIMT appears to change local cerebral perfusion in areas known to participate in movement planning and execution. These changes might be a sign of cortical activation after CIMT in the children with hemiplegic cerebral palsy. Results of this study suggest that modified CIMT may be an effective way of treating children with hemiplegic CP.

Leg Length Discrepancy in Children with Hemiplegic Cerebral Palsy

OBJECTIVE: The purpose of this study was to define the leg length discrepancy (LLD) in hemiplegic cerebral palsy compared with normal control group and to evaluate the contributing clinical factors to LLD. METHOD: The study included 27 children with hemiplegic cerebral plasy and 12 normal control group who were taken Bell-Thomson's view x-ray for measuring of leg length. The patient group was divided into the group with LLD and the group without LLD. Then we evaluated the relationship between the rate of leg length shortening (LLS) and clinical factors. RESULTS: Of the total 27 cerebral palsy children, 18 children (66.7%) had LLD, whose average rate of LLS was 2.0 percent. Nine children didn't have LLD, whose average rate of LLS was 0.6 percent. There was no specific relationship between the rate of LLS and the age, muscle power or spasticity, but there was negative correlation between the rate of LLS and the score of gross motor functional measure (GMFM). CONCLUSION: It is necessary to define the LLD in children with hemiplegic cerebral palsy by the rate of LLS and to be concerned about the LLD due to its possible correlation with poor functional outcome.

A Pilot Evaluation of Cast Immobilization of Intact Upper Extremity: A New Therapeutic Approach for Spastic Hemiplegic Cerebral Palsy

OBJECTIVE: To investigate the functional facilitation effect on an affected side of spastic hemiplegic cerebral palsy by immobilizing the intact side with a cast. METHOD: Five hemiplegic cerebral palsies, who had been treated by general rehabilitation therapy during previous 6 months and showed no functional improvement were studied. Their intact arms were immobilized by scotch short arm casts for 6 weeks. And, the therapeatic effects of this method were evaluated by the Box and Block Test of manual dexterity, Erhardt Developmental Prehension Assesment and Brain Perfusion SPECT. RESULTS: 1. Box and Block test: Before the cast immobilization method, hemiplegic cerebral palsies could transfer a mean of 5.4+/-3.36 cubic rods from one to the other side, and after the treatment a mean of 8.0+/-1.41 cubic rods with the affected arm. 2. Erhardt Developmental Prehension Assesment: Before the treatment, the grasp motion of round rod, cubic rod, and button suited in a mean of 5.1+/-3.0 months, and after the treatment, suited in a mean of 8.2+/-0.66 months. 3. Brain Perfusion SPECTs did not change before and after the cast immobilization method. 4. There was no adverse effect resulting from the cast immobilization method on an intact side. CONCLUSION: We concluded that the cast immobilization method on an intact side could be a new beneficial rehabilitation method for the treatment of spastic hemiplegic cerebral palsies.