Comparing the effect of modified constraint induced movement therapy and bimanual training on body function, activity and participation in primary and middle school children with hemiplegic cerebral palsy: A randomized controlled trial

This study aimed to compare the effects of Modified Constraint-Induced Movement Therapy (mCIMT) and Bimanual Training (BIT) based on the International Classification of Functioning, Disability, and Health's conceptual framework in children with hemiplegic Cerebral Plasy (CP) attending primary and secondary schools. Thirty-two children (mean age 10.43 years [SD 2.9 years]; 15 females, 17 males) whose functional profiles associated with Manual Ability Classification System (MACS), Gross Motor Function Classification System (GMFCS) and Communication Function Classification System (CFCS) changed between level I-III, were randomly distributed to one of the mCIMT or BIT groups with equivalent dosing frequency and intensity (10 weeks/3 days per week/2.5 hours per day). Upper extremity body structure/functions (Modified Ashworth Scale and handheld dynamometer), activity (Quality of Upper Extremity Skills Test, Children's Hand-use Experience Questionnaire, ABILHAND-Kids, Children's Hand‐Skills Ability Questionnaire, and Pediatric Motor Activity Log), and participation outcomes (Child and Adolescent Scale of Participation) were assessed before and after treatment, and at 16 weeks post-intervention. Overall, mCIMT produced more significant improvements in all outcomes than BIT at the immediate post-intervention period, which were maintained better in the mCIMT group throughout the 16-week follow-up period (effect size: dmCIMT>dBIT). However, effect size for the quantity of bimanual use was found to be larger in BIT group than mCIMT group (dBIT=1.41 and dmCIMT =1.23), while the immediate effect of mCIMT for quality of bimanual use parameters was observed better than BIT (ranges of dmCIMT=0.91-0.96 and ranges of dBIT=0.63-0.77). If the goal of the upper limb rehabilitation is to achieve better outcomes in unimanual capacity and developmental non-use in children with hemiplegic CP, mCIMT might be the best choice. In contrast, BIT might be more practical for the problems with spontaneous use of the more affected side. Keywords: Upper limb, hand, bimanual training, constraint-induced movement therapy, ICF, hemiplegic cerebral palsy