Effects of constraint-induced movement therapy as a rehabilitation strategy for the affected upper limb of children with hemiparesis: systematic review of the literature

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Abstract

BACKGROUND: Hand function impairment is the main disability among children with hemiplegic cerebral palsy. They start to perform most motor tasks exclusively with their unaffected upper limb, thereby causing a phenomenon described as learned nonuse. To minimize this phenomenon, constraint-induced movement therapy (CIMT) is emerging as a rehabilitation strategy for improving the functional use of the affected upper limb. OBJECTIVE: The aim of this study was to conduct a systematic review of the literature on the effects of CIMT among children with hemiparetic cerebral palsy. METHOD: This was a systematic review of the literature using randomized clinical trials to analyze the effects of CIMT on the functional performance of the affected upper limb among children with hemiparesis. RESULTS:Five studies fulfilled the inclusion criteria, and the methodological quality ranged from 2 to 6 (4.4±1.36), according to the PEDro scale. The studies included involved a total of 99 individuals who showed that CIMT had positive effects, compared with other rehabilitation strategies or no therapy. However, there was considerable variation between the studies regarding the measurement instruments used and the outcomes evaluated. CONCLUSION: Although the studies achieved positive results, it is difficult to draw any clear-cut conclusion regarding the effectiveness of CIMT because of the small number of studies and their methodological differences.

Translated abstract

CONTEXTUALIZAÇÃO: A deficiência de função manual é a principal incapacidade em crianças com paralisia cerebral do tipo hemiplégica, as quais passam a realizar a maioria das tarefas motoras exclusivamente com o membro superior não acometido, determinando um fenômeno descrito como desuso aprendido. Para minimizar esse fenômeno, a terapia de movimento induzido por restrição (TMIR) emerge como estratégia de reabilitação para melhorar o uso funcional do membro superior acometido. OBJETIVO:O propósito desse estudo foi conduzir uma revisão sistemática da literatura para os efeitos da TMIR em crianças com hemiparesia devido à paralisia cerebral. MÉTODO: Revisão sistemática da literatura com ensaios clínicos aleatorizados analisando os efeitos da TMIR no desempenho funcional do membro superior acometido em crianças com hemiparesia. RESULTADOS:Cinco estudos preencheram os critérios de inclusão e a qualidade metodológica variou entre 2 e 6 (4.4±1.36) de acordo com a escala PEDro. Os estudos incluídos envolveram um total de 99 indivíduos e demonstraram efeitos positivos da TMIR em comparação a outras estratégias de reabilitação ou ausência de terapia. Entretanto, foram encontradas variações consideráveis nos estudos em relação aos instrumentos de medidas utilizados e os desfechos dos estudos. CONCLUSÃO: Embora os estudos tenham alcançado resultados positivos, a definição de uma conclusão sobre a efetividade da TMIR é dificultada em função do pequeno número de estudos e suas diferenças metodológicas.

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Cerebral palsy.

Michael O'Shea (2008)

Extreme prematurity confers about a 100-fold increase in the risk of cerebral palsy (CP), relative to birth at term gestation. Although CP is primarily a disorder of movement, many children with this disorder have other impairments which may affect their quality of life and life expectancy. Epidemiologic and clinical studies of cerebral palsy have benefited from recent efforts to develop greater uniformity of definition and classification. Particularly noteworthy is the development of the Gross Motor Function Classification System, which is a reliable and valid measure used with increasing frequency in observational and experimental studies. Also of great importance are efforts to quantify reliably the quality of life for children with cerebral palsy, thereby providing a target for medical and community interventions that aim to increase participation and well-being among affected children. During the late 1970s and early 1980s, the rate of CP actually rose, presumably as a result of increased survival of especially vulnerable infants who otherwise would have died. In developed countries over the past two decades (late 1980s to present), CP rates have been either stable or decreasing. Although considerable effort is being directed at prevention, the only perinatal interventions for which there is strong evidence of a beneficial effect on both mortality and the risk of CP is antenatal treatment of the mother with glucocorticoid.