Participation outcomes in a randomized trial of 2 models of upper-limb rehabilitation for children with congenital hemiplegia

Arch Phys Med Rehabil. 2011 Apr;92(4):531-9. doi: 10.1016/j.apmr.2010.11.022.


Objective: To determine if constraint-induced movement therapy (CIMT) is more effective than bimanual training to improve occupational performance and participation in children with congenital hemiplegia.

Design: Single-blind randomized comparison trial with evaluations at baseline, 3, and 26 weeks.

Setting: Community facilities in 2 Australian states.

Participants: Referred sample of children (N=64; mean age ± SD, 10.2±2.7y, 52% boys) were matched for age, sex, side of hemiplegia, and upper-limb function and were randomized to CIMT or bimanual training. After random allocation, 100% of CIMT and 94% of the bimanual training group completed the intervention.

Interventions: Each intervention was delivered in day camps (total 60 h over 10d) using a circus theme with goal-directed training. Children receiving CIMT wore a tailor-made glove during the camp.

Main outcome measures: The primary outcome was the Canadian Occupational Performance Measure (COPM). Secondary measures included the Assessment of Life Habits (LIFE-H), Children's Assessment of Participation and Enjoyment, and School Function Assessment.

Results: There were no between-group differences at baseline. Both groups made significant changes for COPM performance at 3 weeks (estimated mean difference =2.9; 95% confidence interval [CI], 2.3-3.6; P<.001 for CIMT; estimated mean difference=2.8; 95% CI, 2.2-3.4; P<.001 for bimanual training) that were maintained at 26 weeks. Significant gains were made in the personal care LIFE-H domain following CIMT (estimated mean difference=0.5; 95% CI, 0.1-0.9; P=.01) and bimanual training (estimated mean difference=0.6; 95% CI, 0.2-1.1; P=.006).

Conclusions: There were minimal differences between the 2 training approaches. Goal-directed, activity-based, upper-limb training, addressed through either CIMT or bimanual training achieved gains in occupational performance. Changes in participation on specific domains of participation assessments appear to correspond with identified goals.

Publication types

  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Activities of Daily Living*
  • Adolescent
  • Arm / physiopathology*
  • Child
  • Child, Preschool
  • Disability Evaluation
  • Disabled Children / rehabilitation*
  • Female
  • Hemiplegia / congenital*
  • Hemiplegia / physiopathology*
  • Hemiplegia / rehabilitation*
  • Humans
  • Male
  • Physical Therapy Modalities*
  • Queensland
  • Single-Blind Method
  • Statistics, Nonparametric
  • Treatment Outcome
  • Victoria