Forced-use therapy for children with cerebral palsy in the community setting: A single-blinded randomized controlled pilot trial

Article type: Research Article

Authors: Eugster-Buesch, Francisca | de Bruin, Eling D. | Boltshauser, Eugen | Steinlin, Maja | Küenzle, Christoph | Müller, Elisabeth | Capone, Andrea | Pfann, Renat | Meyer-Heim, Andreas

Affiliations: Rehabilitation Centre Affoltern am Albis, University Children's Hospital Zurich, Affoltern am Albis, Switzerland | Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland | Neurology Division, University Children's Hospital Zurich, Zurich, Switzerland | Neurology Division, University Children's Hospital Bern, Bern, Switzerland | Rehabilitation Division, Children's Hospital St. Gallen, St. Gallen, Switzerland | Neurology Division, Children's Hospital Aarau, Aarau, Switzerland

Note: [] Corresponding author: Dr. Andreas Meyer-Heim, Rehabilitation Centre, University Children's Hospital Zurich, Mühlebergstr. 104, 8910 Affoltern am Albis, Switzerland. Tel.: +41 44 762 51 11; Fax: +41 11 762 52 11; E-mail: Andreas.Meyer-Heim@kispi.uzh.ch

Abstract: Objective: The aim of this study was to elucidate the feasibility, efficacy, and sustainability of a home-based, two-week, forced-use therapy (FUT) program for children with hemiplegic cerebral palsy (CP). Methods: A single-blinded, randomized controlled design was chosen. The Melbourne Assessment of Unilateral Upper Limb Function (MA) was carried out at baseline, pretest, post-test, and follow-up at two weeks, three months, and 12 months. Additionally, a questionnaire was used to evaluate the clinical relevance and integration of FUT in the home setting. 23 children, ages six to 16 years, took part in the study and were randomized into either an intervention group (n=12, mean age 9.8 ± 3.5 years) or a control group ($n=$ 11, mean age 11.7 ± 3.7 years). The intervention consisted of constraint of the unaffected hand for six hours per day and promotion of different activities of daily living according to an age-related manual for the use of the non-constraint hand. Results: Unpaired t-tests for the change in MA scores relative to the pre-test values showed no difference between the groups at any time point: post-test (p=0.304), two weeks (p=0.193), or three months (p=0.957). Improvements in Activities of Daily Living (ADLs) assessed by questionnaires were observed by 64% of parents of the intervention group. Fifty-five percent of parents stated that the FUT program was exhausting and only 45% indicated that they achieved constraint for 6 hours per day. Conclusion: Our results evaluating a home-based FUT program of 14 days show no statistically significant improvement of upper extremity function in children with CP. The lack of compliance and absence of structured exercises proved to be considerable pitfalls of the home-based FUT program. Therefore, future home based FUT concepts should put special emphasis on the close monitoring and support of children and their families, as well as the integration of structured exercise sessions.

Keywords: Cerebral palsy, child, constraint induced movement therapy, forced-use therapy, hemiparesis

DOI: 10.3233/PRM-2012-0198

Journal: Journal of Pediatric Rehabilitation Medicine, vol. 5, no. 2, pp. 65-74, 2012