Effects of Expanded Constraint-Induced Movement Therapy on Hand Function in Children with Cerebral Palsy: A Randomized Controlled Trial

Abstract

Background: Hemiplegic cerebral palsy children can attend schools regularly, but due to impairment of upper limb function, participation is restricted in leisure and educational tasks and it affects their social and functional activities. Constraint-induced movement therapy is specifically used for the upper extremity and can enhance cerebral palsy children’s hand function.  Objective: To evaluate the effectiveness of expanded constraint-induced movement therapy on hand function in children with cerebral palsy. Methods: A single-blinded randomized controlled trial was conducted at the department of Physical Therapy, Children’s Hospital, Lahore, Pakistan from December 2021 to April 2022 using non-probability convenient sampling. Children with hemiplegic cerebral palsy aged between 5 and 12 years were randomly allocated into two groups (22 patients per group), the experimental group treated with expanded constraint-induced movement therapy and routine physical therapy and the conventional group treated with routine physical therapy only. The pediatric motor activity log scale and Wolf motor function test were the outcome measuring scales. The trial was approved by the ethical committee of the hospital and registered prospectively in the clinical trial registry of the US (ClinicalTrials.gov trial ID 57520). Results: As compared to the conventional group, the score of the pediatric motor activity log scale improved significantly (p-value ≤0.001) in the experimental group. Participants showed significant differences for both domains of the wolf motor function test in the experimental group as compared to other groups and they showed significant improvement in hand function (p≤0.001) within the groups. Conclusion: Expanded constraint-induced movement therapy along with routine physical therapy is found to be more effective in improving the function of the pelagic hand in children with hemiplegic cerebral palsy.