Brain & development · 2025
Hand-arm bimanual intensive therapy versus modified constraint-induced movement therapy in children with hemiparetic cerebral palsy: A randomized controlled trial.
СтатьяРандомизированное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Panda Prateek Kumar, Sharawat Indar Kumar, Gupta Diksha, Palayullakandi Achanya, Kumaran S Senthil, Sherwani Poonam, Sopanam Suthiraj, Neyaz Osama
Аннотация
INTRODUCTION: Modified Constraint-Induced Movement Therapy (mCIMT) and Hand-Arm Bimanual Intensive Therapy (HABIT) are widely used for treating hemiparetic cerebral palsy (CP). Prior randomized controlled trials (RCTs) comparing these approaches yielded mixed outcomes.
METHODS: This RCT evaluated the efficacy of 12 weeks of mCIMT versus HABIT in children aged 5-18 years with hemiparetic CP. Primary objective was to compare improvements in upper limb function (quality of upper extremity skills test [QUEST] total score) in both groups. Secondary objectives were to compare speed of upper limb movements (nine-hole peg board test), muscle strength (thumb strength and hand grip strength), quality of life (CPQoL), compliance to advised therapy in both groups, sustenance of improvement 4 weeks after stopping supervised treatment, and to describe and compare diffusion tensor imaging (DTI) and resting functional magnetic resonance imaging (fMRI) changes. Both groups received 2-h supervised sessions, 8 sessions over 4 weeks, followed by weekly sessions for 8 more weeks. Participants practiced 2 h daily at home, monitored by activity logs and videos when feasible.
RESULTS: Each group had 30 participants. Changes in QUEST total scores after 12 weeks were comparable between HABIT and mCIMT (12.00 ± 7.52 vs. 11.35 ± 7.10, p = 0.48). Individual QUEST domain scores, nine-hole peg test times, thumb and grip strength, and CPQoL improvements were also similar between groups (p>0.05 for all). Both groups showed significant improvements across all outcomes at 12 weeks (p<0.05), maintained at 16 weeks. DTI revealed comparable changes in apparent diffusion co-efficient and fractional anisotropy values in the contralateral corticospinal tract (p = 0.63 and 0.71, respectively). fMRI showed increased activation in the contralateral sensorimotor cortex in both groups at 12 weeks.
CONCLUSION: HABIT and mCIMT demonstrate similar efficacy for upper limb function improvement in children with hemiparetic CP.
METHODS: This RCT evaluated the efficacy of 12 weeks of mCIMT versus HABIT in children aged 5-18 years with hemiparetic CP. Primary objective was to compare improvements in upper limb function (quality of upper extremity skills test [QUEST] total score) in both groups. Secondary objectives were to compare speed of upper limb movements (nine-hole peg board test), muscle strength (thumb strength and hand grip strength), quality of life (CPQoL), compliance to advised therapy in both groups, sustenance of improvement 4 weeks after stopping supervised treatment, and to describe and compare diffusion tensor imaging (DTI) and resting functional magnetic resonance imaging (fMRI) changes. Both groups received 2-h supervised sessions, 8 sessions over 4 weeks, followed by weekly sessions for 8 more weeks. Participants practiced 2 h daily at home, monitored by activity logs and videos when feasible.
RESULTS: Each group had 30 participants. Changes in QUEST total scores after 12 weeks were comparable between HABIT and mCIMT (12.00 ± 7.52 vs. 11.35 ± 7.10, p = 0.48). Individual QUEST domain scores, nine-hole peg test times, thumb and grip strength, and CPQoL improvements were also similar between groups (p>0.05 for all). Both groups showed significant improvements across all outcomes at 12 weeks (p<0.05), maintained at 16 weeks. DTI revealed comparable changes in apparent diffusion co-efficient and fractional anisotropy values in the contralateral corticospinal tract (p = 0.63 and 0.71, respectively). fMRI showed increased activation in the contralateral sensorimotor cortex in both groups at 12 weeks.
CONCLUSION: HABIT and mCIMT demonstrate similar efficacy for upper limb function improvement in children with hemiparetic CP.