R. Gilmore

Upper limb activity measures for 5- to 16-year-old children with congenital hemiplegia: a systematic review.

Aim  This systematic review aimed to compare the validity, reliability, evaluative validity, and clinical utility of upper limb activity measures for children aged 5 to 16 years with congenital hemiplegia.

INCITE: A randomised trial comparing constraint induced movement therapy and bimanual training in children with congenital hemiplegia

BackgroundCongenital hemiplegia is the most common form of cerebral palsy (CP) accounting for 1 in 1300 live births. These children have limitations in capacity to use the impaired upper limb and bimanual coordination deficits which impact on daily activities and participation in home, school and community life. There are currently two diverse intensive therapy approaches. Traditional therapy has adopted a bimanual approach (BIM training) and recently, constraint induced movement therapy (CIMT) has emerged as a promising unimanual approach. Uncertainty remains about the efficacy of these interventions and characteristics of best responders. This study aims to compare the efficacy of CIMT to BIM training to improve outcomes across the ICF for school children with congenital hemiplegia.Methods/DesignA matched pairs randomised comparison design will be used with children matched by age, gender, side of hemiplegia and level of upper limb function. Based on power calculations a sample size of 52 children (26 matched pairs) will be recruited. Children will be randomised within pairs to receive either CIMT or BIM training. Both interventions will use an intensive activity based day camp model, with groups receiving the same dosage of intervention delivered in the same environment (total 60 hours over 10 days). A novel circus theme will be used to enhance motivation. Groups will be compared at baseline, then at 3, 26 and 52 weeks following intervention. Severity of congenital hemiplegia will be classified according to brain structure (MRI and white matter fibre tracking), cortical excitability using Transcranial Magnetic Stimulation (TMS), functional use of the hand in everyday tasks (Manual Ability Classification System) and Gross Motor Function Classification System (GMFCS). Outcomes will address neurovascular changes (functional MRI, functional connectivity), and brain (re)organisation (TMS), body structure and function (range of motion, spasticity, strength and sensation), activity limitations (upper limb unimanual capacity and bimanual motor coordination), participation restrictions (in home, school and recreation), environmental (barriers and facilitators to participation) and quality of life.DiscussionThis paper outlines the theoretical basis, study hypotheses and outcome measures for a matched pairs randomised trial comparing CIMT and BIM training to improve outcomes across the ICF.Trial RegistrationACTRN12609000912280

A balancing act: Children's experience of modified constraint-induced movement therapy

Objective: This qualitative study explored the experiences of children participating in modified constraint-induced movement therapy (CIMT) within a circus-themed day camp. Methods: Individual semi-structured interviews were performed with 32 children (15 girls, 17 boys; mean age 10.1 years) to gain insights into their experience of CIMT. Interviews were audio recorded, transcribed verbatim and independently read by two authors to identify common themes. Results: Three themes emerged from the data: childrens experience of wearing the glove employed in the modified CIMT, their reactions to the camp format and the gains they made during the camp. Conclusion: The results highlighted the need to achieve a balance between the frustration of participating in modified CIMT and what was seen as motivators to sustain involvement. Findings are interpreted in the context of self-determination theory and remind clinicians to ensure interventions consider autonomy, competence and relatedness.

A systematic review of the psychometric properties of Quality of Life measures for school aged children with cerebral palsy.

BackgroundThis systematic review aimed to evaluate the psychometric properties and clinical utility of all condition specific outcome measures used to assess quality of life (QOL) in school aged children with cerebral palsy (CP).MethodsRelevant outcome measures were identified by searching 8 electronic databases, supplemented by citation tracking. Two independent reviewers completed data extraction and analysis of the measures using a modified version of the CanChild Outcome Measures Rating Form.ResultsFrom the 776 papers identified 5 outcome measures met the inclusion criteria: the Care and Comfort Hypertonicity Questionnaire (C&CHQ), the Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD), CP QOL-Child, DISABKIDS and PedsQL 3.0 CP Module. There was evidence of construct validity for all five measures. Content validity was reported for all measures except PedsQL 3.0. The CPCHILD and CP QOL-Child were the only outcome measures to have reported data on concurrent validity. All measures, with the exception of one (C&CHQ) provided evidence of internal reliability. The CPCHILD and the CP-QOL-Child had evidence of test-retest reliability and DISABKIDS had evidence of inter-rater reliability. There were no published data on the responsiveness of these outcome measures.ConclusionsThe CPCHILD and the CP QOL-Child demonstrated the strongest psychometric properties and clinical utility. Further work is needed, for all measures, on data for sensitivity to change.

Comparison of dosage of constraint induced movement therapy versus bimanual training for children with congenital hemiplegia: Is half the dose enough?

Randomized, controlled, assessor-blinded trial of 34 children with hemiplegic CP, aged 18 months to 6 years. Primary outcome was the Assisting Hand Assessment. The mCIMT intervention focused on the hemiplegic hand by restraining the unaffected hand using a neoprene mitt for 3 hours per day. Training used a motor learning approach focusing on repetitive practice of unilateral tasks and activities. Using a bimanual approach to training, OT intervention focused on treatment of hand skills using specific task practice and a motor skill acquisition frame of reference. All children received one hour individual treatment sessions provided by a therapist twice weekly for 2 months.

Pathogenesis of congenital hemiplegia: Relationship between brain structure and upper limb function

Randomized, controlled, assessor-blinded trial of 34 children with hemiplegic CP, aged 18 months to 6 years. Primary outcome was the Assisting Hand Assessment. The mCIMT intervention focused on the hemiplegic hand by restraining the unaffected hand using a neoprene mitt for 3 hours per day. Training used a motor learning approach focusing on repetitive practice of unilateral tasks and activities. Using a bimanual approach to training, OT intervention focused on treatment of hand skills using specific task practice and a motor skill acquisition frame of reference. All children received one hour individual treatment sessions provided by a therapist twice weekly for 2 months.

Neuroscience outcomes in an RCT of constraint induced movement therapy versus bimanual training for children with congenital hemiplegia

Randomized, controlled, assessor-blinded trial of 34 children with hemiplegic CP, aged 18 months to 6 years. Primary outcome was the Assisting Hand Assessment. The mCIMT intervention focused on the hemiplegic hand by restraining the unaffected hand using a neoprene mitt for 3 hours per day. Training used a motor learning approach focusing on repetitive practice of unilateral tasks and activities. Using a bimanual approach to training, OT intervention focused on treatment of hand skills using specific task practice and a motor skill acquisition frame of reference. All children received one hour individual treatment sessions provided by a therapist twice weekly for 2 months.