Constraint induced movement therapy improves upper limb activity and participation in hemiplegic cerebral palsy: a systematic review.
QUESTIONS Does constraint induced movement therapy improve activity and participation in children with hemiplegic cerebral palsy? Does it improve activity and participation more than the same dose of upper limb therapy without restraint? Is the effect of constraint induced movement therapy related to the duration of intervention or the age of the children? DESIGN Systematic review of randomised trials with meta analysis. PARTICIPANTS Children with hemiplegic cerebral palsy with any level of motor disability. INTERVENTION The experimental group received constraint induced movement therapy (defined as restraint of the less affected upper limb during supervised activity practice of the more affected upper limb) The control group received no intervention, sham intervention, or the same dose of upper limb therapy. OUTCOME MEASURES Measures of upper limb activity and participation were used in the analysis. RESULTS Constraint induced movement therapy was more effective than no/sham intervention in terms of upper limb activity (SMD 0.63, 95% CI 0.20 to 1.06) and participation (SMD 1.21, 95% CI 0.41 to 2.02) However, constraint induced movement therapy was no better than the same dose of upper limb therapy without restraint either in terms of upper limb activity (SMD 0.05, 95% CI 0.21 to 0.32) or participation (SMD 0.02, 95% CI 0.34 to 0.31) The effect of constraint induced movement therapy was not related to the duration of intervention or the age of the children. CONCLUSIONS This review suggests that constraint induced movement therapy is more effective than no intervention, but no more effective than the same dose of upper limb practice without restraint. REGISTRATION PROSPERO CRD42015024665. [Chiu H C, Ada L (2016) Constraint induced movement therapy improves upper limb activity and participation in hemiplegic cerebral palsy: a systematic review.Journal of Physiotherapy62: 130 137]
Journal of physiotherapy