Implementation of a hybrid CIMT intervention to improve upper limb function in children with unilateral CP: does duration matter?

Modified Constraint-Induced Movement Therapy (m-CIMT) and bimanual intensive therapy have shown promising results in improving unimanual capacity and bimanual performance in children with unilateral cerebral palsy (CP). However, many questions remain unanswered such as the optimal dosage of the intervention. The incorporation of a bimanual component in m-CIMT training has been defined as hybrid CIMT. This study implemented a hybrid CIMT protocol in two local settings and investigated the difference in efficacy between shorter and longer duration. Twenty-four children (19 males, 5 females; mean age 6y 5mo [SD 1y 3mo]) participated in either a 5-day (n=17) or a 9-day camp (n=7). All children received 4 hours of m-CIMT, followed by 3 hours of bimanual training. Results showed an improvement in bimanual performance for both camps (AHA; p=0.0002 [5-day camp]; p=0.016 [9 day camp]) and unimanual capacity (Melbourne Assessment, MUUL; p=0.0002 [5-day camp]; p=0.016 [9-day camp]). No between-group differences were found (p=0.52 [AHA]; p=0.06 [MUUL]) although the MUUL showed a trend toward significance. Effect sizes indicated a small effect (.22) for AHA and a large effect (.87) for the MUUL, in favor of the 9-day camp. Children with a lower baseline AHA benefited significantly more from both interventions compared to children with a higher baseline AHA score (p=0.04). The results of this study indicate a small better outcome in favor of the longer duration camp, but further research is needed to confirm these findings in a larger sample.status: publishe