Affiliations: [a] Department of Paediatrics, Monash University, Clayton, Victoria, Australia | [b] CPtherapy, Australian Catholic University, Victoria, Australia | [c] Occupational Therapy Department, The Royal Children's Hospital, Victoria, Australia
Abstract: BACKGROUND: There is high-level evidence supporting constraint-induced movement therapy
(CIMT) and bimanual therapy for children with unilateral cerebral palsy.
Evidence-based intervention includes time-limited, goal-directed,
skills-based, intensive blocks of practice based on motor learning theory. AIM AND METHODS: Using supporting literature and clinical insight, we provide a theoretical
rationale to highlight previously unreported differences between CIMT and
bimanual therapy. DISCUSSION: The current emphasis on total dosage of practice for achieving positive
outcomes fails to recognise the influence of other critical concepts within
motor learning. Limitations exist in the application of motor learning
principles using CIMT due to its unimanual nature. CIMT is effective for
development of unimanual actions brought about by implicit learning, however
it is difficult to target explicit learning that is required for learning
how to use two hands together. Using bimanual therapy, object properties can
be adapted to trigger goal-related perceptual and cognitive processes
required for children to learn to recognise when two hands are required for
task completion. CONCLUSION: CIMT and bimanual should be viewed as complementary. CIMT could be used to
target unimanual actions. Once these actions are established, bimanual
therapy could be used for children to learn how to use these actions for
bimanual skill development.
Keywords: Cerebral palsy, constraint-induced movement therapy, bimanual therapy, motor learning theory
