Forced-use, Without Therapy, in Children with Hemiplegia: Preliminary Study of a new Approach for the Upper Limb

Author(s): Motta F, Antonello CE and Stignani C

Source: J Pediatr Orthop 30(6):582-587, 2010.

Summary:

The use of constrained induced movement therapy or forced-use therapy in children with cerebral palsy remains controversial.  In hemiparesis, the goal is to limit the movement of the normal arm to enhance movement of the affected arm.  Animal work has demonstrated increased “activity” when this technique is utilized.  Twenty children with hemiplegia younger than 10 years of age were enrolled in this study.  Ten patients agreed to proceed with the constraint treatment, while ten declined constraint.  Therefore, two groups were compared with regard to outcome.  There were no considerable differences between the two cohorts.

Treatment was carried out over 21 days, during which the child wore a fixed short armed fiberglass cast that extended from just below the elbow to the finger tips of the unaffected hand.  None of the children received any rehabilitation treatment, but rather just participated in their normal activities of daily living.  The participants were assessed before treatment, after three weeks, and at three months following intervention.  The assessments included validated outcome measures. 

The results indicate that there was no difference in the two groups at baseline.  Subsequently, in the constrained group, there was a statistically increase on both the functional scales after three weeks which was maintained at three months. 

In summary, the authors do show increase use of the affected arm at short term follow-up.  The overriding question is whether statistical significance equates to functioning significance?  In addition, it is unclear whether or not the short term positive results will persist throughout a lifetime.  Further studies are necessary to answer this complex clinical question.