Research Review on CIMT and Bimanual Therapy for Children with Cerebral Palsy

Research Review on CIMT and Bimanual Therapy for Children with Cerebral Palsy

Pediatric Physical Therapy published a systematic review comparing modified constraint-induced movement therapy (CIMT) and intensive bimanual therapy in upper limb function in children with unilateral cerebral palsy.  After searching 4 electronic databases from 2009-2015, eight articles met the inclusion criteria with a total of 221 participants who received either intensive bimanual therapy or modified CIMT.

The results indicated the following:

• both intensive bimanual therapy and modified CIMT improved quality of unimanual movement, bimanual capacity, and movement efficiency.
• a weak, specific recommendation for intensive bimanual therapy in improving movement quality
• a specific but weak recommendation favoring intensive bimanual therapy to improve the child’s performance on parent-reported outcomes.

Reference:  Klepper, S. E., Krasinski, D. C., Gilb, M. C., & Khalil, N. (2017). Comparing Unimanual and Bimanual Training in Upper Extremity Function in Children With Unilateral Cerebral Palsy. Pediatric Physical Therapy, 29(4), 288-306.

Read more about unilateral cerebral palsy:

Motor Learning in Children with Unilateral Cerebral Palsy

Goal-Directed OT Programs for Unilateral Cerebral Palsy

Tactile Function of Children with Cerebral Palsy

CIMT, Bimanual Therapy, and OT Home Programs

Therapeutic Play Activities for Children digital download includes 100 play activity pages and 12 tip sheets. The play activities encourage the development of fine motor skills, bimanual skills, rolling, crawling, tall kneeling, standing balance and cruising with a strong focus on children with cerebral palsy.  FIND OUT MORE INFORMATION.

 

 

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Modified Constraint-Induced Movement Therapy Versus Intensive Bimanual Training

Clinical Rehabilitation published research on 47 children with unilateral cerebral palsy or other non-progressive hemiplegia (aged 3.3–11.4 years) who were randomly assigned to either a modified constraint-induced movement program (kid-CIMT - 60 hours of unilateral constraint-induced and 20 hours of bimanual training over four weeks) or intensive bimanual training (80 hours of bimanual training over four weeks). The following results were recorded: 

• modified constraint-induced therapy provided a significantly better outcome for isolated motor functions of the paretic arm than bimanual training 
• for spontaneous use of the paretic arm and hand in everyday life activities both methods led to similar improvement 
• more-disabled children showed greater improvement than less-disabled ones 
• age did not affect treatment outcome 

 
Reference: Wolfgang Deppe,Kerstin Thuemmler,Judith Fleischer,Claudia Berger,Susanne Meyer,and Baerbel Wiedemann. Modified constraint-induced movement therapy versus intensive bimanual training for children with hemiplegia – a randomized controlled trial Clin Rehabil October 2013 27: 909-920, first published on July 1, 2013 doi:10.1177/0269215513483764

Does CIMT Effect Gait and Balance?

What an interesting question to raise...does constraint induced movement therapy (CIMT) effect gait characteristics, balance and functional locomotor ability? The researchers evaluated 16 children, who participated in a 3 week CIMT program, with the Standardized Walking Obstacle Course (SWOC), the Pediatric Balance Scale (PBS) and the GAITRite Gold system. The children underwent a pretest and post test during the 3 week CIMT program. The results indicated a significant difference in faster cadence and faster velocity. No changes were recorded on the PBS or the SWOC. Reference: Zipp, Genevieve Pinto; Winning, Sue. Effects of Constraint-Induced Movement Therapy on Gait, Balance, and Functional Locomotor Mobility. Pediatric Physical Therapy. 24(1):64-68, Spring 2012. doi: 10.1097/PEP.0b013e31823e0245

Bimanual Versus Constraint Therapy in Hemiplegia

Research was conducted comparing two groups of children ranging from 3.5 to 10 years old (42 in total) with hemiplegia. The children were randomly assigned to receive 90 hours of constraint induced movement therapy (CIMT) or 90 hours of bimanual training (HABIT). Following the training, both the CIMT and HABIT resulted in improved hand function as seen in scores on the Jebsen-Taylor Test of Hand Function (JTTHF) and Assisting Hand Assessment (AHA) scores. In addition, the Goal Attainment Scales revealed greater progress toward goals with the HABIT group. The researchers concluded that both treatment interventions, CIMT and HABIT, resulted in similar improvements in hand function with the HABIT possibly improving more on self determined goals.

Reference: Gordon AM, Hung YC, Brandao M, Ferre CL, Kuo HC, Friel K, Petra E, Chinnan A, Charles JR. Bimanual Training and Constraint-Induced Movement Therapy in Children With Hemiplegic Cerebral Palsy: A Randomized Trial. Neurorehabil Neural Repair. 2011 Jun 23. [Epub ahead of print]