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      Randomized controlled trial combining constraint-induced movement therapy and action-observation training in unilateral cerebral palsy: clinical effects and influencing factors of treatment response

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          Abstract

          Introduction:

          Constraint-induced movement therapy (CIMT) improves upper limb (UL) motor execution in unilateral cerebral palsy (uCP). As these children also show motor planning deficits, action-observation training (AOT) might be of additional value. Here, we investigated the combined effect of AOT to CIMT and identified factors influencing treatment response.

          Methods:

          A total of 44 children with uCP (mean 9 years 6 months, SD 1 year 10 months) participated in a 9-day camp wearing a splint for 6 h/day and were allocated to the CIMT + AOT ( n = 22) and the CIMT + placebo group ( n = 22). The CIMT + AOT group received 15 h of AOT (i.e. video-observation) and executed the observed tasks, whilst the CIMT + AOT group watched videos free of biological motion and executed the same tasks. The primary outcome measure was bimanual performance. Secondary outcomes included measures of body function and activity level assessed before (T1), after the intervention (T2), and at 6 months follow-up (T3). Influencing factors included behavioural and neurological characteristics.

          Results:

          Although no between-groups differences were found ( p > 0.05; η 2 = 0–16), the addition of AOT led to higher gains in children with initially poorer bimanual performance ( p = 0.02; η 2 = 0.14). Both groups improved in all outcome measures after the intervention and retained the gains at follow up ( p < 0.01; η 2 = 0.02–0.71). Poor sensory function resulted in larger improvements in the total group ( p = 0.03; η 2 = 0.25) and high amounts of mirror movements tended to result in a better response to the additional AOT training ( p = 0.06; η 2 = 0.18). Improvements were similar irrespective of the type of brain lesion or corticospinal tract wiring pattern.

          Conclusions:

          Adding AOT to CIMT, resulted in a better outcome for children with poor motor function and high amounts of mirror movements. CIMT with or without AOT seems to be more beneficial for children with poor sensory function.

          Trial registration:

          Registered at ClinicalTrials.gov on 22nd August 2017 (ClinicalTrials.gov identifier: NCT03256357).

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          Most cited references 49

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          Eta-Squared and Partial Eta-Squared in Fixed Factor Anova Designs

           J J Cohen (1973)
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            The Assisting Hand Assessment: current evidence of validity, reliability, and responsiveness to change.

            The Assisting Hand Assessment (AHA) provides a new perspective of hand function evaluation relevant for children with unilateral upper limb disabilities. It measures how effectively the involved hand is actually used for bimanual activity, which, for these children, might be the most important aspect of their hand function. The aim of this paper is to report the conceptual framework and the evidence for validity, reliability, and responsiveness to change for the measures. Previously, the AHA has been evaluated for children aged 18 months to 5 years and excellent inter- and intrarater reliability was demonstrated. This paper reports further evidence of construct validity and reliability for the AHA measures involving an extended age range of children with hemiplegic cerebral palsy or obstetric brachial plexus palsy from 18 months to 12 years of age (mean age 4y 11mo [SD 2y 9mo] range 18mo-12y 8mo). A Rasch measurement model was used to analyze 409 assessments from 303 children (170 males, 133 females). The analysis generated a scale demonstrating large capacity to reliably separate and spread personal ability measures, indicating sensitivity to change and a hierarchy of the items ranging them from easy to hard. Aspects of item fit, relationship between age and ability measures, and development of assisting hand function are discussed.
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              Effects of constraint-induced movement therapy in young children with hemiplegic cerebral palsy: an adapted model.

              The aim of this study was to evaluate the effects of a modified version of constraint-induced (CI) movement therapy on bimanual hand-use in children with hemiplegic cerebral palsy (CP; age range 18 mo to 4 y) and to make a comparison with conventional paediatric treatment. Twenty-one children (13 females, eight males) completed the CI therapy programme and 20 children (12 males, eight females) served as a control group. Children in the CI therapy group were expected to wear a restraint glove for 2 hours each day over a period of 2 months. The training was based on principles of motor learning used in play and in motivational settings. To evaluate the effect of treatment, the Assisting Hand Assessment (AHA) was used. Assessments took place on three occasions: at onset, after 2 months, and 6 months after the first assessment. A significant interaction was found between group and AHA measure (ANOVA, F(2,74) = 5.64, p = 0.005). The children who received CI therapy improved their ability to use their hemiplegic hand significantly more than the children in the control group after 2 months, i.e. after treatment. Effect size was high after treatment and remained medium at 6 months. As the treatment was tailored to each child's capacity and interests, little frustration was experienced by the children.
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                Author and article information

                Contributors
                Journal
                Ther Adv Neurol Disord
                Ther Adv Neurol Disord
                TAN
                sptan
                Therapeutic Advances in Neurological Disorders
                SAGE Publications (Sage UK: London, England )
                1756-2856
                1756-2864
                6 January 2020
                2020
                : 13
                Affiliations
                KU Leuven, Department of Rehabilitation Sciences, Herestraat 49, bus 1510, Leuven, 3000, Belgium
                Information Systems Institute, University of Applied Sciences Western Switzerland (HES-SO Valais) Sierre, Switzerland
                KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
                KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
                KU Leuven, Department of Development and Regeneration, Leuven, Belgium
                Neural Control of Movement Lab, Department of Health Sciences and Technology, ETH Zurich, Switzerland
                Neural Control of Movement Lab, Department of Health Sciences and Technology, ETH Zurich, Switzerland
                Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Calambrone, Italy
                Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
                Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Calambrone, Italy
                Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
                KU Leuven, Department of Development and Regeneration, Leuven, Belgium
                KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
                Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
                KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
                Author notes
                [†]

                contributed equally as senior authors.

                Article
                10.1177_1756286419898065
                10.1177/1756286419898065
                6977217
                © The Author(s), 2020

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                Funding
                Funded by: Onderzoeksraad, KU Leuven, FundRef https://doi.org/10.13039/501100004497;
                Award ID: 3M140230
                Funded by: Fonds Wetenschappelijk Onderzoek, FundRef https://doi.org/10.13039/501100003130;
                Award ID: G087213N
                Categories
                Original Research
                Custom metadata
                January-December 2020
                ts1

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