Best responders to constraint induced movement therapy versus bimanual training for children with congenital hemiplegia

Best responders to constraint induced movement therapy versus bimanual training for children with congenital hemiplegia
L SAKZEWSKI BOCCTHY 1.3, R BOYD PHD PT 1.3,R GILMORE BSCOT 1, K PROVAN BOCCTHY 3,
K CORN BSCOT 1, J ZIVIANI PHD OT 2
1Queensland Cerebral Palsy and Rehabilitation Research Centre, University of Queensland, Brisbane, QLD;
2Division of Occupational Therapy, University of Queensland, Brisbane, QLD;
3Neurosciences, Brain Research Instituite , Melbourne, VIC, Australia

Background/Objectives: To delineate features of children with congenital hemiplegia who had greatest improvements in an RCT comparing two methods of upper limb training.
Design: Secondary analyses of a single blind matched pairs randomised comparison trial.
Participants and Setting: Sixty-four children with congenital hemiplegia (32 pairs) matched for age (mean 10.2 years (range 5-16), gender (36 males) and side of hemiplegia (36 right sided) were randomly allocated to either constraint induced movement therapy (CIMT) or bimanual training (BIM).
Materials/Methods: Each intervention was delivered in a “day camp” for 6 hours/day over 10 days. All groups received the same intensity, duration of activities but differing intervention modes. Outcomes were compared at baseline and 6 months with the assisting hand assessment (AHA); Melbourne assessment of unilateral upper limb function (MUUL), jebsen taylor hand function test (JTHFT), sensory impairment (two point discrimination and stereognosis). Logistic regression analyses (STATA 10) were used to determine factors that predicted best responders in each group on bimanual performance and unimanual capacity with the independent variables, baseline unimanual or bimanual performance, age, and sensory impairment.
Results: Twenty-two of the 64 children (11 CIMT, 11 BIM) had clinically important change ≥4 raw scores on the AHA. Results for movement efficiency (JTHFT), unimanual capacity (MUUL) and bimanual performance (AHA) were highly correlated, so only AHA was used in the predictive model. (i) For CIMT:- Baseline AHA raw score were the only variable contributing to the model (x2=5.91; P=0.02). For every one point increase in AHA baseline score there is a 0.1 decrease in the log odds of best responders (Wald test (z) =2.0; P=0.04). Best responders for unimanual capacity (n=7, all in CIMT group) recorded a change of ≥10% on MUUL. Other than group allocation, no independent variables predicted better outcomes in unimanual capacity. (ii) In the BIM group: no independent variables were identified to predict best responders for bimanual performance. Unexpectedly, age (<12 or ≥12 years) , presence of sensory impairments and baseline unimanual capacity did not predict bimanual performance.
Conclusions/Significance: Both intervention groups had equal best responders with gains in bimanual performance (AHA), however children with the lowest baseline AHA scores achieve better gains with CIMT. Age and the presence of sensory impairments did not influence response. Clinicians should consider tailoring CIMT programs for children with poorest baseline bimanual function, and focus BIM programs for those with adequate bimanual performance and occupational goals.

 
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