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Arch Phys Med Rehabil. 2011 Apr;92(4):578-84. doi: 10.1016/j.apmr.2010.12.003.

Best responders after intensive upper-limb training for children with unilateral cerebral palsy.

Author information

1
Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, Faculty of Health, The University of Queensland, Brisbane, Australia. leanne.sakzewski@uqconnect.edu.au

Abstract

OBJECTIVE:

To delineate characteristics of best responders in a randomized trial comparing constraint-induced movement therapy (CIMT) to bimanual training for children with unilateral cerebral palsy.

DESIGN:

Secondary analysis of a single-blind matched-pairs randomized comparison trial.

SETTING:

Community sporting facilities in 2 Australian capital cities.

PARTICIPANTS:

Children (n=64; mean age, 10.2±2.7y; 52% boys), matched for age, sex, side of hemiplegia, and upper-limb function, were randomized within pairs to CIMT or bimanual training. Sixty-one children who completed CIMT (n=31) or bimanual training (n=30) were included in this study.

INTERVENTIONS:

Each intervention was delivered in day camps (total 60h over 10d) using a novel circus theme with goal-directed training.

MAIN OUTCOME MEASURES:

Change between baseline, 3, and 26 weeks on the Melbourne Assessment of Unilateral Upper Limb Function (MUUL>7.4%), Assisting Hand Assessment (AHA>4 raw score points), and Canadian Occupational Performance Measure (COPM>2 points) defined best responders.

RESULTS:

Poorer baseline hand function predicted a best response for unimanual capacity of the impaired upper limb (MUUL) immediately postintervention; however, at 26 weeks the odds of achieving a favorable outcome were 21 times greater for CIMT than bimanual training. A favorable response for bimanual performance (AHA) was predicted by immediate change in Jebsen-Taylor hand function test scores. Age (older), left-sided hemiplegia, and lower-baseline COPM performance scores significantly predicted favorable individualized outcomes.

CONCLUSIONS:

Secondary analysis of a randomized trial directly comparing 2 upper-limb training models, found children with poorer hand function benefited most. Favorable outcomes for bimanual performance were associated with gains in movement efficiency and older children with left-sided hemiplegia achieved more favorable gains in perceived occupational performance.

PMID:
21440702
DOI:
10.1016/j.apmr.2010.12.003
[Indexed for MEDLINE]

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