Yoona Choi, Sunjoo Kang, Jin Sun Kim, Insook Kwon, Myungken Lee
School Health Needs Assessment in Chanchamayo, Peru: A Health Promoting School Project
Frontiers in public health
unilateral cerebral palsy cp condition affects muscle control function one side body children unilateral cp experience difficulties using hands together secondary disturbances occur developing fetal infant brain often affected limb disregarded constraintinduced movement therapy cimt aims increase use affected upper limb improve bimanual performance cimt based two principles restraining use less affected limb example using splint mitt sling intensive therapeutic practice affected limb evaluate effect constraintinduced movement therapy cimt treatment affected upper limb children unilateral cp march 2018 searched central medline embase cinahl pedro otseeker five databases three trials registers also ran citation searches checked reference lists contacted experts handsearched key journals searched using google scholar randomised controlled trials rcts clusterrcts clinically controlled trials implemented children unilateral cp aged 0 19 years cimt compared different form cimt low dose highdose dosematched alternative form upperlimb intervention bimanual intervention primarily outcomes bimanual performance unimanual capacity manual ability secondary outcomes included measures selfcare body function participation quality life two review authors independently screened titles abstracts eliminate ineligible studies five review authors paired extract data assess risk bias included study grade assessments undertaken two review authors included 36 trials 1264 participants published 2004 2018 sample sizes ranged 11 105 mean 35 mean age 596 years standard deviation sd 182 range three months 198 years 53 male 47 participants left hemiplegia fiftyseven outcome measures used across studies average length cimt programs four weeks range one 10 weeks frequency sessions ranged twice weekly seven days per week duration intervention sessions ranged 05 eight hours per day mean total number hours cimt provided 137 hours range 20 504 hours common constraint devices mittglove sling 11 studies eachwe judged risk bias moderate high across studies primary outcomes primary endpoint immediately interventioncimt versus lowdose comparison eg occupational therapywe found lowquality evidence cimt effective lowdose comparison improving bimanual performance mean difference md 544 assisting hand assessment aha units 95 confidence interval ci 237 851cimt effective lowdose comparison improving unimanual capacity quality upper extremity skills test quest dissociated movement md 595 95 ci 202 987 grasps md 757 95 ci 210 1305 weight bearing md 592 95 ci 221 96 protective extension md 1254 95 ci 860 1647 three studies reported adverse events including frustration constraint refusal reversible skin irritations castingcimt versus highdose comparison eg individualised occupational therapy bimanual therapywhen compared highdose comparison cimt effective improving bimanual performance md 039 aha units 95 ci 314 236 evidence cimt effective highdose comparison improving unimanual capacity single study using quest dissociated movement md 049 95 ci 1071 1169 grasp md 020 95 ci 1184 1144 two studies reported children experienced frustration participating cimtcimt versus dosematched comparison eg hand arm bimanual intensive therapy bimanual therapy occupational therapythere evidence differences bimanual performance groups receiving cimt dosematched comparison md 080 aha units 95 ci 078 238there evidence cimt effective dosematched comparison improving unimanual capacity box blocks test md 111 95 ci 006 228 melbourne assessment md 148 95 ci 049 344 quest dissociated movement md 651 95 ci 074 1376 grasp md 663 95 ci 238 1565 weightbearing md 231 95 ci 802 340 except protective extension domain md 686 95 ci 014 1358there evidence differences manual ability groups receiving cimt dosematched comparison abilhandkids md 074 95 ci 031 118 15 studies two children tolerate cimt three experienced difficulty quality evidence conclusions low low children unilateral cp evidence cimt resulted improved bimanual performance unimanual capacity compared lowdose comparison compared highdose dosematched comparison based evidence available cimt appears safe children cp