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There is some Level 2b evidence (RCTs) of low methodological quality to support the use of Constraint-Induced Movement Therapy with children who have a hemiparesis

Prepared by:

Margaret Wallen,
Senior Occupational Therapist – Research
The Children’s Hospital at Westmead.
Email: margarew@chw.edu.au

Date:

Revised May 2006

Review Date:

May 2008

Clinical Question:

 What is the evidence that constraint induced movement therapy (CIMT) is effective in improving upper limb function in children?

Clinical Scenario:

 Constraint-induced movement therapy (CIMT) and forced use therapy refer to restraining the unaffected arm of people with hemiplegia to “force” the affected arm into use. Restraint may range from wearing of a mitt which restricts grasp to immobilization of the limb in a plaster cast and/or a sling. The constraint may be in place for a few hours per day to most of the waking hours. In the form advocated by its chief proponent, Edward Taub, CIMT (but not forced use therapy) is also accompanied by intensive therapy (massed practice) to facilitate function in the affected arm. The underlying rationale for CIMT is that ‘forcing’ use of the affected arm reverses the learned non-use of the limb. Several reports of CIMT used with the adult stroke population have been published including a systematic review (Hakkennes & Keating, 2005), but it is not clear whether there is a place for CIMT in paediatrics.

Clinical Bottom Line:

       

There is weak evidence that CIMT, involving use of plaster cast with or without intensive practice, appears to improve upper limb function more than routine therapy alone, when used with children up to 8 years of age who have a hemiparesis.

BB

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