CIMT IN CHILDREN WTH CP

Author/Date

Design/ Variables
Measures/

Sample

Findings

Data Collection

Gordon, 2011

Geerdink, et al.,
2012

More than 100

participants in
CIMT/bimanual
training since 1997.
52 children with CP
2.5-8 years

Review

RCT
Comparing CIMT-BiT to
conventional therapy, two
groups
Accessing learning curve.
IV: conventional therapy
received or participated in
the mCIMT-BiT Pirate
group
DV: unimanual capacity
(studied progression of
manual dexterity and
factors affecting the motor
learning curve)

Sakzewski, et al.,
2011

64 children with
unilateral cerebral
palsy, mean age is
10.2 +2.7years, 52%
male

Single blind matched pairs

comparison trial.
Participants were matched
for age, gender, side of
hemiplegia, and upper-limb
function were randomized
into pairs, one of the pair
participating in CIMT and
the other in bimanual
training.

Review other RCTs

CIMT vs. HABIT

1.) At high intensities CIMT and bimanual training improve dexterity and bimanual UE
use. 2.) Bimanual training may allow direct practice of functional goals that is
transferred to unpracticed goals and improve bimanual coordination. 3.) 90 hours leads to
greater improvements than 60 hours of same Tx. 4.) higher doses may be required for
bimanual training 5.) increased dosing frequency may be needed for older children. 6.)
combined CIMT/bimanual approaches may be useful but requires sufficient intensity.

Box and Block test (measurable progress and

established baselines)
Manual ability classification system (MACS)
during selection process
Follow up assessments 6 mos. and 1 year post
intervention
Melbourne Assessment of Unilateral Upper Limb
Function (assess long-term effects with COPM)
Statistical testing

1. Age was found to significantly affect the learning-curve. 2. Long term retention of
effects was not influenced by age. 3. Children five years and older may profit from more
than 54 hours of mCIMT training.

Change between baseline, 3, and 26 weeks on the

Melbourne Assessment of Unilateral Upper Limb
Function, Assisting Hand Assessment, and
Canadian Occupational Performance Measure

1. Both groups had changes in range of motion. 2. Bimanual training group changed most
in grasp and release items. 3. CIMT group changed most in hand-to-hand transfer and
target accuracy. 4. Nearly 70% of the kids achieved best response for perceived
occupational performance (as assessed by the COPM) with no difference between
groups. 5. Kids with left hemiplegia were more likely to achieve a best response. 6.
Children who were older selected their own goals and were that much more engaged and
motivated in the therapy processbest achievement of favorable individualized
outcomes. 7. Long term retention effects are more likely with CIMT

CIMT IN CHILDREN WTH CP

IV: Receiving BiT or

mCIMT intervention
DV: increased UL function,
movement efficacy, and
occupational gains

Author/Date

Design/ Variables
Measures/

Sample

Findings

Data Collection

Choudhary, et al.,
2012

Modified CIMT
combined with
Bimanual
Aarts, et al., 2010

31 children 3-8 years

old with hemiplegic
cerebral palsy

RCT (single blind)

52 children with
unilateral spastic CP
with Manual Ability
Classification System
(MACS) scores I, II
or III and aged 2.58
years

RCT follow up
Non-experimental
Observation of tasks
(muffin decorating and
beading)

IV: Intervention received;

control group received OT
and physiotherapy for 20
min in their home vs.
mCIMT
DV: improved arm function
as measured with hole-peg
test and sustainability of
skills at a 8 week check in.

Evaluated 3 times with QUEST (quality of upper

extremity skills test) and complete the 9 holepegboard test

-Found the modifications of CIMT to fit childrens needs were feasible, effective, and
well tolerated
- Increase activity rather than addressing impairments to improve activity limitations
-Significant improvement in dissociated movements in the mCIMT group
-improved in the peg-test by 60 seconds with mCIMT compared to 5 seconds in the
control group
- The results of this single blind, randomized controlled trial suggest that the modified
constraint induced movement therapy of 4 weeks duration is effective in improving
upper limb functions in children with hemiplegic cerebral palsy.
-The improvement in upper limb functions was sustained 8 weeks after discontinuation
of intervention.

Assisting Hand Assessment (AHA);

ABILHAND-Kids; Goal Attainment Scale;
COPM

-This study indicate that the observed improvements of upper limb capacity and
performance after 8 weeks mCIMTBiT in children with unilateral spastic CP are based
on a better utilization of existing motor functions of the affected extremity, rather than on
true restoration of muscle strength or motor selectivity.
-In contrast with current definitions of developmental disregard that focus on the amount
of use, the quality of upper limb control may be an equally important aspect of learned
non-use
-Their improvement of hand capacity did not reach a level of sufficient automaticity in
order to enhance the overall amount of spontaneous use.

Developmental disregard was assessed with

VOAA-DDD (integral test)

CIMT IN CHILDREN WTH CP

Gordon, et al.,
2005

Started in 1997
Pilot and
experimental testing
with 38 children
between ages 4 and
14 with congenital
hemiplegia
Authors also
referenced other
studies

Author/Date

Non-experimental
Describes methodology of
mCIMT as a child-friendly
intervention and seeks to
define mCIMT more
specifically in literature.

-Unimanual speed: Jebsen-Taylor Test of Hand

Funciton, Bruininks-Oseretsky Test of Motor
Proficiency
-Unimanual quality: Melbourne Assessment of
Unilateral Upper Limb Function, Quality of UE
Skills test
-Bimanual: B-O Test, Assisting Hand Assessment
(new!)
-ADL Performance: caregiver reports via logs,
WeeFIM, Pediatric evaluation of disability
inventory

-defines CIMT and describes application with children in detail

-demonstrated that CIMT can be successfully modified for children 4-14 with hemiplegic
Cerebral Palsy
-mCIMT keeps repetivie practive and shaping aspects of adult CIMT
-developed a child friendly approach because the only attrition was 1 child asked to leave
due to his level of frustration
-needs further research so this methodology can be applicable to children with
hemiplegia from other etiologies (stroke, TBI, etc.)

Measures/

Findings

Design/ Variables
Sample

Data Collection

Brandao et al.,
(2012)

16 children with
hemiplegia due to
cerebral palsy
between the ages of
3-10 yo
10 males
6 females
9 with left side
hemiplegia
7 with right side
hemiplegia

RCT
CIMT vs HABIT to
effectively increase upper
limb function affected by
hemiplegia
IV- CIMT intervention or
HABIT intervention
DV- Self care performance
& functional performance
of UE

15 day series with 6hr daily sessions as well as 1

hour of practice with parent at home
A pre and post test measurement
PEDI and COPM interviews with parents to
establish functional skill goals for children as
well as establish self care abilities conducted by
OT

Both CIMT and HABIT were significantly effective treatments to help increase upper
limb function
No significant evidence that one is better than the other

CIMT IN CHILDREN WTH CP

Wu et al. (2013)

Sutcliffe et al.
(2007)

8 children with
hemiplegia die to
cerebral palsy
between ages 2-11
4 girls
4 boys

1 8 yo male child
with right congenital
hemiplegic cerebral
palsy

Quasi experimental
CIMT in a group setting
IV- group CIMT
intervention
DV- Functional
performance

Single case study

Effect of CIMT on cortical
reorganization
IV- modified CIMT
intervention
DV- Cortical
Reorganization and
function performance of
UE

Author/Date

Peabody developmental Motor Scales- Second

edition
2.5 hr a day 5 times/week for 4 weeks
One pretest measurement and 3 post test
measurements
PEDI interview with parents to establish
functional skill abilities conducted by OT

CIMT effective treatments to help increase upper limb function

More research to be done on group effectiveness of group CIMT with population

Continuous casting of unaffected arm for 3 weeks

with weekly 1 hour sessions with an OT
A pre and post test measurement
Use of the Pediatric Motor Activity Log, Quality
of Extremity Skills Test, COPM, Assisting Hand
Assessment, MRI, EMG, and
sphygmomanometry

Cortical reorganization did occur in the contralateral somatosensory area following

CIMT intervention.
CIMT resulted n increased function of affected upper limb.

Design/ Variables
Measures/

Sample

Findings

Data Collection

Gelkop et al.
(2015)

12 children with
cerebral hemiplegia.
Age range between 1
- 7 yo
CIMT group
1 male
5 females
3 left hemiplegia

RCT for CIMT vs HABIT

intervention in a school
setting

2 hour daily sessions that were half one on one

and group sessions
6 day a week for 8 weeks

IV- modified CIMT

intervention or HABIT
intervention both in a
school setting

Two pretest measurements and Two post test

measurements

DV- Functional

Found that improvements in affected upper limb can be achieved when the amount of
time used for intervention is modified and incorporated into the regular school day.
They did not find any significant difference between CIMT and HABIT

Assessments used were Assisting Hand

Assessment (AHA), Quality of Upper Extremity

CIMT IN CHILDREN WTH CP

3 right hemiplegia

performance of UE
and Performance of
bimanual tasks

Skills Test (Quest), and the Manual Ability

Classification System (MACS).

25 children with
cerebral hemiplegia
age range between

Randomized crossover
design with a washout
period

18 months and 4 yo
Group 1
9 males
3 females
Group 2
9 males
4 females

Eco-CIMT intervention on
upper in affected upper
limb function

One two would start as control group while group

1 participated in 2 hour intervention with parent
or preschool teacher everyday for 2 months.
There then was a 4 month washout time and the
groups switched

46 children with
cerebral palsy
hemiplegia

Quasi RCT
CIMT vs HABIT
intervention as effective
intervention for upper limb
function of affected side

HABIT group
1 male
5 females
3 left hemiplegia
3 right hemiplegia

Eliasson et al.
(2011)

Gordon et al.
(2011)

CIMT
9 male
12 female
15 right hemiplegia
6 left hemiplegia
HABIT
11 male
10 Female
9 right hemiplegia

IV- CIMT intervention or

HABIT intervention
DV- Performance in hand
function

Assisting Hand Assessment conducted by OT

Randomly assigned to CIMT or HABIT group

completed 90 hours of therapy
Participated in 6 hours a day of therapy for 15
consecutive days
A total of six CIMT and HABIT day camps from
July of 2007 to 2009 with 2-5 participating in
each camp
One pretest measurement and two posttest
measurements one immediately following the
conclusion and another at 6 month follow up
Participants assessed using the Assisted Hand
Assessment (AHA) and the Jebsen- Taylor Test of

Found significant increase in affected arm function using Eco-CIMT intervention.

Emphasized that individuals will make different ranges of improvements
Suggest that environment plays a part and intervention is effective when parents or
preschool teacher are implementing it with the coaching of an OT. Suggest that when a
parent is interventionist there can be improved results because the child is with someone
they are familiar with in a familiar setting.

Results showed that CIMT and HABIT both show significant increases in the affected
upper limb function, but did not do so in the manner they hypothesized of each treatment
having specificity to it.
Results were obtained in only three weeks time and still maintained at the 6 month
follow up
Still more research to be done

CIMT IN CHILDREN WTH CP

12 left hemiplegia

hand Function (JTTHF) and evaluated by a

physical therapist blinded to allocation of groups