Hand-arm bimanual intensive therapy versus modified constraint-induced movement therapy in children with hemiparetic cerebral palsy: A randomized controlled trial.

INTRODUCTION

Modified Constraint-Induced Movement Therapy (mCIMT) and Hand-Arm Bimanual Intensive Therapy (HABIT) are widely used for treating hemiparetic cerebral palsy (CP). Prior randomized controlled trials (RCTs) comparing these approaches yielded mixed outcomes.

METHODS

This RCT evaluated the efficacy of 12 weeks of mCIMT versus HABIT in children aged 5-18 years with hemiparetic CP. Primary objective was to compare improvements in upper limb function (quality of upper extremity skills test [QUEST] total score) in both groups. Secondary objectives were to compare speed of upper limb movements (nine-hole peg board test), muscle strength (thumb strength and hand grip strength), quality of life (CPQoL), compliance to advised therapy in both groups, sustenance of improvement 4 weeks after stopping supervised treatment, and to describe and compare diffusion tensor imaging (DTI) and resting functional magnetic resonance imaging (fMRI) changes. Both groups received 2-h supervised sessions, 8 sessions over 4 weeks, followed by weekly sessions for 8 more weeks. Participants practiced 2 h daily at home, monitored by activity logs and videos when feasible.

RESULTS

Each group had 30 participants. Changes in QUEST total scores after 12 weeks were comparable between HABIT and mCIMT (12.00 ± 7.52 vs. 11.35 ± 7.10, p = 0.48). Individual QUEST domain scores, nine-hole peg test times, thumb and grip strength, and CPQoL improvements were also similar between groups (p>0.05 for all). Both groups showed significant improvements across all outcomes at 12 weeks (p<0.05), maintained at 16 weeks. DTI revealed comparable changes in apparent diffusion co-efficient and fractional anisotropy values in the contralateral corticospinal tract (p = 0.63 and 0.71, respectively). fMRI showed increased activation in the contralateral sensorimotor cortex in both groups at 12 weeks.

CONCLUSION

HABIT and mCIMT demonstrate similar efficacy for upper limb function improvement in children with hemiparetic CP.