Effect of treatment environment on modified constraint-induced movement therapy results in children with spastic hemiplegic cerebral palsy: a randomized controlled trial

Purpose: To determine the effects of treatment environment (home and clinic) on results of modified constraint-induced movement therapy (modified CIMT) in children with spastic hemiplegic cerebral palsy. Method: In a single-blinded, randomized, controlled trial, 14 children with spastic hemiplegic cerebral palsy (5 females, 9 males; mean age: 74 months) received 15 hours of modified CIMT, occurring three times/week for 10 sessions every other day in two randomly assigned groups. Each session lasts one and half hours. Treatment environment for intervention group (n = 7) was home and for control group (n = 7) was clinic. Measures were conducted pre, post and 3 months after treatment period by pediatrics motor activity log and subtests 5 (upper limb coordination) and 8 (upper limb speed and dexterity) of Bruininks–Oseretsky test of motor proficiency. Sample randomization and data analysis by analysis of variance with repeated measures were conducted by SPSS-16 software in α level set at p < 0.05. Results: All subjects showed significant improvement (p < 0.01) in post-test measures except subtest 5 of Bruininks–Oseretsky test of motor proficiency. In contrast to clinic group, subjects in home showed significantly continued improvement at follow-up session in all measures. Conclusions: Modified CIMT is effective in improving upper limb function in children with spastic hemiplegic cerebral palsy. In addition, more improved performance in home group places the practice in natural context as the preferred method for treatment of these children.Implications for RehabilitationIn hemiplegic cerebral palsy, one side of the body is more affected, which is a consequence of non-progressive impairments in the brain.Constraint-induced movement therapy tries to improve upper limb function of hemiparetic children by restraint of the less-affected hand and intensive training of the more-affected hand.This study shows more improvement of hand function through implementing constraint-induced movement therapy in home than clinic.In a randomized, controlled trial, our study shows the positive effects of practice in natural environments compared to simulated environments such as clinic.