Constraint-Induced Movement Therapy in Obstetrical Brachial Plexus Palsy: A Single-Blind Pilot Randomized Controlled Trial.

AIM: To estimate the effectiveness of Constraint-Induced Movement Therapy (CIMT) vs. conventional therapy in improving the frequency, quality, and spontaneity of the affected arm usage and acquiring new motor programs in children with Obstetrical Brachial Plexus Palsy (OBPP).

METHODS

Pilot, randomized, and controlled clinical trial with a blind evaluator. Twenty (N = 20) children with OBPP diagnoses were divided into Intervention Group (CIMT protocol, 5x/week, 3h/day, 3 wk) and Control Group (conventional Physiotherapy/Occupational Therapy 2x/week, 40 min/day, 3 wk). Pediatric Mal Activity Log - Revised (PMAL-R) was used for quality and frequency measures; Pediatric Arm Function Test (PAFT) was used to measure the spontaneous use of the affected upper limb; Inventory of New Motor Activities and Programs (INMAP) was used for the acquisition of new motor programs. All the evaluations were applied pre and post treatment.

RESULTS

CIMT was superior compared to control in terms of frequency (mean change= 1.58; 95% CI 0.83 to 2.33; p < 0.001) and quality of movement (mean change= 1.53; 95% CI 0.78 to 2.28; p < 0.001), in spontaneity of use in unimanual tasks in PAFT (mean change= 2.9; 95% CI 1.29 to 4.5; p = 0.022) and in the INMAP (mean change= 1.4; 95% CI 0.70-2.10; p < 0.001). All the effect sizes for the differences were large, and MCID showed large effects for PMAL-R and PAFT.

CONCLUSION

CIMT is favored over standard care, with gains in terms of quality and frequency of movement, spontaneity of use, and acquisition of motor programs.