Aarts PB et al.(1717 Aarts PB, Jongerious PH, Geerdink YA, van Limbeek J, Geurts AC. Effectiveness of modified constraint-induced movement therapy in children with unilateral spastic cerebral palsy: a randomized controlled trial. Neurorehabil Neural Repair. 2010;24(6):509-18. doi: 10.1177/1545968309359767
https://doi.org/10.1177/1545968309359767...
) |
n = 52 (2 dropouts) CIMT-BIT = 28 Control = 22 |
2.5 to 8 years CP with unilateral, bilateral or severely asymmetrical impairment MACS I, II or III |
Both groups provided with games and functional activities CIMT-BIT: Unimanual activities with affected limb in first 6 weeks with unaffected limb constrained in sling; goal-oriented bimanual activities in last 2 weeks Control: Conventional therapy involving goal-oriented activities with affected limb; training performed at home and school by parents and teachers |
CIMT-BIT: 8 weeks x 3 sessions/week x 3 hr = 72 hr (at rehabilitation center) Control: 8 weeks x 2 sessions/week x 1 hour = 12 hr (at rehabilitation center); 8 weeks x 7.5 hr/week = 60 hr (at home) |
Primary outcomes: Assisting Hand Assessment (AHA) ABILHAND-KIDS Secondary outcomes: Melbourne Assessment of Unilateral Upper Limb Function (MUUL) Canadian Occupational Performance Measure (COPM) Goal Attainment Scaling (GAS) |
Two children withdrawn from control group due to family circumstances after randomization, impeding true intention-to-treat analysis |
Aarts PB et al.(1818 Aarts PB, Jongerious PH, Geerdink YA, van Limbeek J, Geurts AC. Modified constraint-induced movement therapy combined with bimanual training (mCIMT-BiT) in children with unilateral spastic cerebral palsy: how are improvements in arm-hand use established? Res Dev Disabil. 2011;32(1):271-9. doi: 10.1016/j.ridd.2010.10.008
https://doi.org/10.1016/j.ridd.2010.10.0...
) |
n = 50 CIMT-BIT = 28 Control = 22 |
2.5 to 8 years CP with unilateral, bilateral or severely asymmetrical impairment MACS I, II or III |
Both groups provided with games and functional activities CIMT-BIT: Unimanual activities with affected limb in first 6 weeks with unaffected limb constrained in sling; goal-oriented bimanual activities in last 2 weeks Control: Conventional therapy involving goal-oriented activities with affected limb; training performed at home and school by parents and teachers |
CIMT-BIT: 8 weeks x 3 sessions/week x 3 hr = 72 hr (at rehabilitation center) Control: 8 weeks x 2 sessions/week x 1 hour = 12 hr (at rehabilitation center); 8 weeks x 7.5 hr/week = 60 hr (at home) |
Determine Developmental Disregard module of Video Observations Aarts and Aarts, (VOAA-DDD) Active and passive range of motion of wrist and elbow (goniometer) |
Two children withdrawn from control group due to family circumstances after randomization, impeding true-to-treat analysis |
Brandão MB et al.(1919 Brandão MB; Gordon AM; Mancini MC. Functional impact of constraint therapy and bimanual training in children with cerebral palsy: a randomized controlled trial. Am J Occup Ther. 2012;66(6):672-81. doi:10.5014/ajot.2012.004622
https://doi.org/10.5014/ajot.2012.004622...
) |
n = 16 CIMT = 8 HABIT = 8 |
3 to 10 years Hemiparesis with difference of at least 50% between limbs on timed motor tasks of Jebsen-Taylor Hand Function Test Wrist extension capacity at least 20°; fingers with 10° of complete flexion Normal cognitive skills |
Both groups provided with games, fine and gross motor activities (individual and group activities) CIMT: Unimanual activities involving affected limb with unaffected limb constrained in sling, complemented with unimanual or bimanual practice of activities of daily living and games at home HABIT: Bimanual activities in accordance with appropriate age, complemented with unimanual or bimanual practice of activities of daily living and games at home |
CIMT: 15 days x 6 hr./day = 90 hr. (rehabilitation center); 15 days x 1 hr./day = 15 hr. (at home) HABIT: 15 days x 6 hr./day = 90 hr (rehabilitation center); 15 days x 1 hr/day = 15 hr (at home) |
Pediatric Evaluation of Disability Inventory (PEDI) Canadian Occupational Performance Measure (COPM) |
Not possible to administer COPM directly to children since some participants were too young to understand the content of the questionnaire and provide a reliable result. |
Brandão MB et al.(2020 Brandão MB, Mancini MC , Vaz DV, Fonseca ST. Adapted version of constraint-induced movement therapy promotes functioning in children with cerebral palsy: a randomized controlled trial. Clin Rehabil. 2010;24(7):639-47. doi: 10.1177/0269215510367974
https://doi.org/10.1177/0269215510367974...
) |
n = 16 (1 dropout) Intervention = 8 Control = 7 |
4 to 8 years Spastic hemiparetic CP Understand verbal commands Execute proposed activities |
Intervention: Unimanual fine motor tasks involving affected limb in first 2 weeks with unaffected limb constrained in sling during therapy and at home (total: 10 h); routine daily bimanual activities during last week Control: Conventional therapy with functional activities, bimanual activities and sensory stimulation |
Intervention: 2 weeks x 5 sessions/week x 3 hr = 30 hrs; 1 week x 3 sessions/day x 45 min = 11 hr 15 min Control: 3 weeks x 1 session/week x 45 min = 2 hr 15 min |
Jebsen-Taylor Hand Function Test (JTHF) Pediatric Evaluation of Disability Inventory (PEDI) |
One child in control group interrupted study due to family problems. |
Chen HC et al.(2121 Chen HC, Chen CL, Kang LJ, Wu CY, Chen FC, Hong WH. Improvement of upper extremity motor control and function after home-based constraint induced therapy in children with unilateral cerebral palsy: immediate and long-term effects. Arch Phys Med Rehabil. 2014;95(8):1423-32. doi: 10.1016/j.apmr.2014.03.025
https://doi.org/10.1016/j.apmr.2014.03.0...
) |
n = 48 (3 dropouts) Home CIT = 23 Traditional rehabilitation (TR) = 22 |
6 to 12 years Spastic unilateral CP Considerable non-use of affected limb Wrist and MCP joints ≥ 10º Absence of excessive muscle tone in affected limb |
Both groups received individualized at-home intervention with functional activities Home-Based CIT: Unimanual activities involving affected limb with unaffected limb constrained by elastic band and mitt; encouraged by parents to perform daily functional activities with affected limb TR: Guided unimanual and bimanual activities; encouraged by parents to perform daily functional unilateral and bilateral activities |
Home-Based CIT: 4 weeks x 2 sessions/week x 3.5 to 4 hr = 32 hr TR: 4 weeks x 2 sessions/week x 3.5 to 4 hr = 32 hr |
Primary outcomes Bruininks-Oseretsky Test of Motor Proficiency (BOTMP) Peabody Developmental Motor Scales, Second Edition (PDMS-2) Secondary outcomes Functional Independence Measure for children (WeeFIM) Kinematic and clinical evaluations |
One child in TR group unable to complete follow-up due to family schedule and lack of transportation to post-intervention evaluation One child in each group excluded due to insufficient motor skills to conclude kinematic evaluation of reaching task |
Chen CL et al.(2222 Chen CL, Kang LJ, Hong WH, Chen FC, Chen HC, Wu CY. Effect of therapist-based constraint-induced therapy at home on motor control, motor performance and daily function in children with cerebral palsy: a randomized controlled study. Clin Rehabil. 2013;27(3):236-45. doi: 10.1177/0269215512455652
https://doi.org/10.1177/0269215512455652...
) |
n = 48 (1 dropout) CIMT = 24 Traditional rehabilitation (TR) = 23 |
6 to 12 years Unilateral spastic CP Considerable non-use of affected limb (score on PMAL “how often” scale less than 2.5) Wrist and MCP joints ≥ 10º Absence of excessive muscle tone in affected limb (≤ 2 on Ashworth scale) |
Both groups received individualized intervention with functional activities CIMT: Unimanual activities involving affected limb with unaffected limb constrained by elastic band and mitt; encouraged by parents to perform daily functional activities with affected limb TR: Guided unimanual and bimanual activities; encouraged by parents to perform daily functional unilateral and bilateral activities |
CIMT: 4 weeks x 2 sessions/week x 3.5 to 4 hr = 32 hr TR: 4 weeks x 2 sessions/week x 3.5 to 4 hr = 32 hr |
Peabody Developmental Motor Scales, Second Edition (PDMS-2) Pediatric Motor Activity Log (PMAL) Kinematic and clinical evaluations |
One child in TR group unable to complete follow-up due to family schedule and lack of transportation to post-intervention evaluation |
Choudhary A et al.(2323 Choudhary A, Gulati S, Kabra, M, Singh UP, Sankhyan N, Pandey RM, et al. Efficacy of modified constraint induce movement therapy in improving upper limb function in children with hemiplegic cerebral palsy: a randomized controlled trial. Brain Dev. 2013;35(9):870-6. doi: 10.1016/j.braindev.2012.11.001
https://doi.org/10.1016/j.braindev.2012....
) |
n = 31 (1 dropout) CIMT = 15 Control = 15 |
3 to 8 years Hemiparetic CP with minimum difference between upper limbs of 10 points on QUEST Understand simple commands Sit without support See objects at distance of 1 m |
CIMT: Unimanual reaching activities involving paretic limb with unaffected limb wrapped in triangular bandage Control: Conventional therapy with stretching, strengthening, bimanual activities and practice of activities of daily living |
CIMT: 10 days distributed over 4 weeks x 2 h/day = 20 hr (at rehabilitation center) Control: 4 weeks x 20 min/day = 10 hr (at home) |
Primary outcomes Quality of Upper Extremity Skills Test (QUEST) Secondary outcomes QUEST score Nine-hole pegboard |
One patient in CIMT group received 5 supervised intervention sessions, but did not return for scheduled visits afterward. |
Hsin YJ et al.(2424 Hsin YJ, Chen FC, Lin KC, Kang LJ, Chen CL, Chen CY. Efficacy of constraint-induced therapy on functional performance and health-related quality of life for children with cerebral palsy: a randomized controlled trial. J Child Neurol. 2012; 27(8):992-9. doi: 10.1177/0883073811431011
https://doi.org/10.1177/0883073811431011...
) |
n = 22 CIMT = 11 Control = 11 |
6 to 8 years Spastic unilateral CP Considerable non-use of affected limb (score on PMAL “how often” scale less than 2.5) Wrist and MCP joints ≥ 10º Absence of excessive muscle tone in affected limb (≤ 2 on Ashworth scale) |
Both groups received individualized intervention with functional activities at home CIMT: Unimanual activities involving affected limb with unaffected limb constrained by elastic bandage and mitt; encouraged by parents to perform daily functional activities with affected limb Control: Guided unimanual and bimanual activities; encouraged by parents to perform daily unimanual and bimanual functional activities |
CIMT: 4 weeks x 2 sessions/week x 3.5 to 4 hr = 32 hr Control: 4 weeks x 2 sessions/week x 3.5 to 4 hr = 32 hr |
Primary outcome Subtest 8 - Bruininks-Oseretsky Test of Motor Proficiency (BOTMP) Secondary outcomes Pediatric Motor Activity Log (PMAL) Cerebral Palsy-Specific Quality of Life (CPQOL) |
No difficulties described |
Sakzewski L et al.(2525 Sakzewski L, Ziviani J, Boyd RN. Best responders after intensive upper-limb training for children with unilateral cerebral palsy. Arch Phys Med Rehabil. 2011;92(4):578-84. doi: 10.1016/j.apmr.2010.12.003
https://doi.org/10.1016/j.apmr.2010.12.0...
) |
n = 64 (3 dropouts) CIMT = 31 BIT = 30 |
5 to 16 years Congenital hemipareiss Understand commands Muscle tone of affected limb grade 1 to 3 on Ashworth scale |
Both groups provided with fine and gross motor activities, functional reach activities and balance activities in setting with circus theme CIMT: Unaffected limb constrained by mitt during unilateral activities BIT: Guided bimanual activities |
6 hr/day x 10 days = 60 hr (daily camping) |
Primary outcomes Melbourne Assessment of Unilateral Upper Limb Function (MUUL) Assisting Hand Assessment (AHA) Canadian Occupational Performance Measure (COPM) |
Three children did not complete intervention program. |
Sakzewski L et al.(2626 Sakzewski L, Miller L, Ziviani J, Abbott D, Rose S, Macdonell RA, et al. Randomized comparison trial of density and context of upper limb intensive group versus individualized occupational therapy for children with unilateral cerebral palsy. Dev Med Child Neurol. 2015;57(6):539-47. doi: 10.1111/dmcn.12702
https://doi.org/10.1111/dmcn.12702...
) |
n= 53 (9 dropouts) Hybrid-CIMT = 25 Standard Care = 19 |
5 to 16 years Unilateral CP Understand commands Muscle tone of affected limb grade 1 to 3 on Ashworth scale |
Both groups provided with fine and gross motor activities, functional reach activities and balance activities in setting with circus theme Hybrid-CIMT: Unaffected limb constrained by mitt during unilateral activities; bimanual activities performed in second week Standard Care: Bimanual activities; at-home training with parents |
Hybrid-CIMT: 6 hr/day x 10 days = 60 hr (daily camping) Standard Care: 1.5 hr/day x 6 days = 9 hr (daily camping) 12 weeks x 6 sessions/week x 30 min = 36 hr (at home) |
Primary outcomes MUUL AHA Secondary outcomes COPM JTTHF Box and Block Test Children’s Hand-use Experience Questionnaire (CHEQ) |
Six children withdrew from Standard Care group and 3 withdrew from Hybrid-CIMT One child had seizure due to fever during intervention program. |
Case-Smith J et al.(2727 Case-Smith J, DeLuca SC, Stevenson R, Ramey SL. Multicenter randomized controlled trial of pediatric constraint-induced movement therapy: 6-month follow-up. Am J Occup Ther. 2012;66(1):15-23. doi: 10.5014/ajot.2012.002386
https://doi.org/10.5014/ajot.2012.002386...
) |
n = 18 3-hr = 9 6-hr = 9 |
3 to 6 years Unilateral CP |
Both groups submitted to intensive intervention in natural environment - functional activities, activities of daily living, reaching and sensory perception First 18 days - Unilateral activities involving affected limb with unaffected limb constrained by cast Last 3 days - bimanual activities |
3-hr: 4 weeks x 21 days x 3 hr = 63 hr 6-hr: 4 weeks x 21 days x 6 hr = 126 hr (performed in three different clinical settings) |
Assisting Hand Assessment (AHA) Quality of Upper Extremity Skills Test (QUEST) Pediatric Motor Activity Log (PMAL) |
One child in 3-hr group and two in 6-hr group did not undergo six-month follow-up evaluation due to scheduling difficulties. |
Wallen M et al.(2828 Wallen M, Ziviani J, Naylor N, Evans R, Novak I, Herbert RD. Modified constraint-induced therapy for children with hemiplegic cerebral palsy: a randomized trial. Dev Med Child Neurol. 2011;53(12):1091-9. doi: 10.1111/j.1469-8749.2011.04086.x
https://doi.org/10.1111/j.1469-8749.2011...
) |
n = 50 CIMT = 25 Intensive occupational therapy (IOT) = 25 |
1.5 to 8 years Spastic hemiparetic CP 10º wrist and finger extension of affected limb Functional passive range of motion of affected limb Cooperation |
Both groups provided with functional and play activities CIMT: Unilateral activities involving affected limb with unaffected limb constrained by mitt IOT: Bimanual activities complemented with at-home program supervised by parents |
8 weeks x 7 sessions/week x 2 hr = 112 hr |
Primary outcomes Canadian Occupational Performance Measure (COPM) Secondary outcomes Goal Attainment Scaling(GAS) Assisting Hand Assessment (AHA) Pediatric Motor Activity Log (PMAL) Modified Tardieu Scale (MTS) Ashworth |
No difficulties described |
