There were significant within
group changes for both groups on each primary outcome (mean change score JTTHF –137 s, 95% CI –174 to –99; mean change score AHA –0.49 logits, 95% CI 0.25 to 0.73) which were maintained at the 6 month follow-up. There were also significant within group changes for both groups for the QUEST and physical activity assessments. The bimanual therapy group made greater progress than the CIMT group on their Goal Attainment Scale scores (mean difference between groups 8.1 T-score, 95% CI 0.7 to 15.5). Conclusion: CIMT and bimanual therapy resulted in similar improvements in hand BI 2536 mw function among young children with congenital hemiplegia. The bimanual therapy group made better progress on established goals. [Mean difference between groups calculated by the CAP Editor] Constraint induced movement therapy (CIMT) has emerged as a promising upper limb rehabilitation approach for children with congenital hemiplegia. Until recently, CIMT has been compared to control groups receiving standard care or no treatment, raising questions whether improvements gained were a result
of treatment methods or intensity of intervention (Sakzewski et al 2009). Gordon et al’s (2011) results suggest the latter and confirm similar findings (Facchin et al 2011, Sakzewski et al 2011) that either intensive treatment approach leads to sustained improvement in upper limb function and achievement of individualised Crizotinib purchase goals. Both approaches are goal directed and provide intensive repetitive task practice using incremental challenges to drive changes in upper limb function. While results from either approach are similar, the interventions are not the same. CIMT changes the role of the impaired hand. It becomes the dominant hand with unimanual activities aimed to improve dexterity and efficiency of movement of that limb. It is assumed that gains in unimanual abilities will translate to improved bimanual performance, a premise supported by results of this study. In bimanual training, the role of the impaired upper limb remains
as the assisting hand with therapy aiming to improve bimanual co-ordination and goal achievement through carefully tailored bimanual activities. Therefore, the choice of either approach will depend on a child’s individual goals, and consideration of to behavioural aspects (eg, tolerance of restraint). The current study delivered 90 hours of therapy over a three week period. While results of this well designed and rigorous study are positive, translation of such intensive models of intervention into a real world clinical setting is challenging. There remains limited data to suggest the optimum dosage required for either approach. What is clear is that current standard practice probably does not offer sufficient intensity of intervention necessary to drive sustained changes in upper limb function for children with congenital hemiplegia.