| Objective: Upper extremity dysfunction is the primary cause of limited participation in daily and social activities in children with hemiplegic cerebral palsy(HCP).Based on high quality evidence,constraint-induced movement therapy(CIMT)is the only strongly recommended rehabilitation therapy for HCP upper limb dysfunction.It has been shown that CIMT is effective in improving motor function of affected upper limb and participation in daily life in children with hemiplegia over 2years old.With the development of early identification and diagnostic techniques for children at risk for or with cerebral palsy,early intervention for cerebral palsy is also gaining attention.Baby-CIMT is infant-friendly CIMT specifically developed for children with or at risk of HCP under 2 years old.Based on the same motor learning theory as the CIMT,hand-arm bimanual intensive therapy(HABIT)is aims to improve the upper limb motor function of children with HCP.The difference between CIMT and HABIT is that HABIT does not restrict the non-affected upper limb of children with HCP.Age 0-2 is the period with the strongest neuroplastic,during which the effective interventions can promote the repairment and functional reorganization of neural network in the damaged brain,which potentially minimizes the extent of brain injury and function impairment caused by the injury and optimizes clinical developmental outcomes.Previous studies have suggested that Baby-CIMT could improve upper limb motor function in infants with HCP.However,it is unclear that how well the rehabilitation efficacy of Baby-CIMT is when compared to equal doses of motor learning therapy,such as HABIT,and what the medium-term effects on physical structure and function,mobility,participation,and neurodevelopment of infants with HCP is.Therefore,the aim of this study is to observe the rehabilitation efficacy of Baby-CIMT for treating upper limb dysfunction and its medium-term effects on the function of the affected hand,bimanual motor performance,participation of daily activities and the level of neurodevelopment in infants and toddlers with HCP under 2 years old,providing a scientific basis for timely intervention at the stage of greatest neuroplasticity.Methods: This was a randomized controlled study.A total of 19 infants and toddlers with HCP under 2 years old,attending the rehabilitation department of Guangzhou Women and Children’s Medical Center from February 2022 to September2022,were recruited in this study.Stratified by Mini-Manual Ability Classification System(Mini-MACS)level I and Ⅱ,the participatants were randomly divided into two groups by using the random number table,with 10 children in the experimental group and 9 children in the control group.Both groups attended a 10-day,30-hour upper-extremity-function structural rehabilitation camp,with the experimental group receiving Baby-CIMT during which the non-affected hand restricted while the control group receiving HABIT without any upper extremity restrictions.Evaluation of motor function of the affected upper extremity [Bayley infant and toddler developmental assessment Scale(Bayley)-affected hand score,Global rating scale(GRS),infant motor activity log(IMAL),and accelerometers],bimanual motor performance[Bayley-FM,Peabody developmental motor scale version 2(PDMS2)-grasp and PDMS2-visual-motor integration)],daily activity and participation skills(Canadian operational performance measure,COPM)and neurodevelopmental level(Hammersmith infant neurological examination,HINE)were performed at baseline(T0),at the end of the upper-extremity-function structured rehabilitation camp(T1),and 3 months(T2)and 6 months(T3)after the camp,respectively.And adverse events were recorded.One-way repeated measures ANOVA was used to compare the upper extremity motor function,bimanual motor performance and participation of daily activity within the two groups,and independent samples t-test or Wilcoxon signed rank sum test was used to compare the difference of improved scores between the two groups.Paired-sample and independent-sample t-tests were used to compare the improvement in neurodevelopmental levels between the two groups before and after the intervention.Results:(1)Intergroup comparison of the basic information and assessment results on the baseline between the two groups showed that the mean age of the experimental group was greater than that of the control group(P<0.05),and the scores of Bayley-FM,PDMS2-grasp,PDMS2-visual-motor integration and COPMperformance were higher in the experimental group than that in the control children(P<0.05).(2)Regarding the function of the affected upper limb,compared to T0,the motor function of the affected upper extremity was significantly improved at all time points after treatment in both groups(P<0.05);the score of Bayley-affected side improved by 3.0 in the experimental group and by 2.0 in the control group at T1,and the comparison between groups showed a statistically significant difference(P<0.05).(3)In terms of the bimanual motor performance,compared to T0,both the two groups have a significant improvement at all time points after treatment(P<0.05);however,the difference of the improvement values between the two groups was not statistically significant(P>0.05).(4)In terms of participation in daily activities,the COPM scores were significantly improved at all time points after treatment compared to that at T0 in both two groups(P<0.05);however,there was no significant difference between the two groups(P>0.05).(5)Regrading of neurodevelopmental level,compared to T0,the total HINE score in the experimental group improved by 1.95 points while the control group improved by 1.77 points at T1,and the difference was statistically significant(P<0.05),but the difference was not statistically significant between the two groups(P>0.05).(6)None of the children in the two groups had any adverse events that required further medical treatment related to the intervention of this study.Conclusion: Baby-CIMT is safe and feasible to be applied to infants and toddlers with HCP under 2 years old without adverse events,and is effective in improving upper extremity motor function,bimanual coordination,participation in daily activities and neurodevelopment.With the same dose,Baby-CIMT can achieve a higher immediate improvement in the motor function of the affected upper extremity compared with HABIT.This study provides an evidence-based basis for Baby-CIMT intervention during the period with strong neuroplasticity. |
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