Efficacy of constraint-induced movement therapy and electrical stimulation on hand function of children with hemiplegic cerebral palsy: a controlled clinical trial

Purpose: The purpose of this study is to compare the efficacy of constraint therapy, constraint therapy plus electrical stimulation, and occupational therapy in the treatment of hand dysfunction. Methods: Sixty-eight children with hemiplegic cerebral palsy were randomly allocated to constraint therapy, constraint therapy plus electrical stimulation, and occupational therapy group. Three groups received 2 weeks of treatment. All participants were measured at baseline and 2 weeks, 3 and 6 months after treatment using measures of active ROM, grip strength, nine-peg hole test, upper extremity functional test, Peabody developmental motor scales (PDMS), globe rating scale, and social life ability scale. Results: Three groups improved significantly (p < 0.05). The mean improvements between baseline and the end of follow-up were respectively 12.4, 11.4 and 11.3 degrees for active ROM; 12.8, 10.5 and 8.8 mmHg for grip strength; ?22.3, ?30.7 and ?14.0 s for nine-peg hole test; 15.3, 10.3 and 10.4 for upper extremity functional test scores; 2.2, 1.8 and 1.8 for grasping scores of PDMS; 5.8, 3.7 and 2.8 for visual-motor integration scores of PDMS; 2.0, 2.5 and 0.9 for globe rating scale scores; 7.7, 5.7 and 5.3 for social life ability scale scores in constraint therapy plus electrical stimulation, constraint therapy, and occupational therapy group. The constraint therapy plus electrical stimulation group showed greater rate of improvement in upper extremity functional test scores (p < 0.05) and visual-motor integration scores of PDMS (p < 0.05) than the other two groups after treatment for 6 months. Conclusions: Constraint therapy plus electrical stimulation is likely to be best in improving hand performance in children with hemiplegic cerebral palsy.

Implications for Rehabilitation

• Children with hemiplegic cerebral palsy have major hand dysfunction problems that not only restrict activity and participation but also lead to secondary impairment.

• Constraint therapy, constraint therapy plus electrical stimulation and occupational therapy, is the technique available to these children. However, strong evidence for efficacy of the three interventions is still lacking.

• This study shows that all the three interventions improve hand performance and perceived changes. However, constraint therapy plus electrical stimulation is the most effective. Use of constraint therapy is advantageous in improving involved hand function and perceived changes.