Constraint-induced Movement Therapy and Self-regulation for Children With Cerebral Palsy
Constraint-induced Movement Therapy and Self-regulation for Children With Cerebral Palsy
This study examines the effect of combining modified constraint-induced movement therapy
 (mCIMT) and self-regulation (SR) in promoting upper limb function of children with hemiplegic
 cerebral palsy (CP) studying in a school-based setting.
Children diagnosed with hemiplegic CP are involved. A within-subject design is used with
 children acting as their own controls. The study is scheduled at three-week intervals. All
 children undergo conventional occupational therapy (OT) and modified constraint-induced
 movement therapy plus self-regulation (mCIMT + SR) program in a random order.

 Both programs last for three weeks. Each program is followed by a three-week no-treatment
 period to measure the carry-over effect. The OT program consists of training on unimanual and
 bimanual tasks for 1 to 2 hours a week with daily home exercise. The mCIMT + SR program
 involves restraint of the unaffected upper limb of children using a cotton sling for 6 hours
 per day for 15 days. A one-hour structured task practice with the use of SR is provided
 during each 6-hour restraint.

 The Bruininks-Oseretsky Test of Motor Proficiency, the Jebsen-Taylor Test of Hand Function,
 the Caregiver Functional Use Survey, a hand dynamometer, pinch gauge, and modified Ashworth
 scale are used for evaluation. All children are assessed for five times at 3-week interval:
 once before and twice after the conventional OT; and twice after the mCIMT + SR at 1 week and
 at 3 weeks.

 Before and after the three-week intervention, the children participate in event-related
 potentials (ERP) sessions with a choice reaction task. Event-related potentials (ERP)
 technique is used to capture the changes in neural mechanism after intervention.
Inclusion Criteria:

 -  children with diagnosis of hemiplegic CP,

 -  6-18 years of age studying at local special school for students with physical handicap
 (PH),

 -  intelligence ranging from normal to mild grade mental retardation,

 -  the ability to extend the wrist at least 20° and the metacarpophalangeal joint 10°
 from full flexion, and

 -  no balance problems sufficient to compromise safety.

 Exclusion Criteria:

 -  any health problems that were not associated with CP, and

 -  severe muscle tone with modified Ashworth scale scored greater than 3.