“Remind to Move” Treatment Versus Constraint-induced Movement Therapy for Children With Hemiplegic Cerebral Palsy

Overview

The aim of this study was to determine the effects of an innovative child-friendly remind-to-move treatment (RTM) treatment by comparing it with constraint-induced movement therapy (CIMT) on upper extremity outcomes in children with hemiplegic Cerebral Palsy. In an evaluator-blinded randomized controlled trial, 73 children, among of whom 20 in Manual Ability Classification System level I, 38 level II, and 15 level III, were recruited from 3 special schools and randomized to receive 75-hour RTM (n=25) and CIMT (n=24) programme over 15-weekdays, and conventional treatment (n=24). The primary outcomes were Jebsen-Taylor Hand Function Test (JTHFT) and Bruininks-Oseretsky Test of Motor Proficiency (BOTMP-II) Subtest 3 for assessing the motor efficiency at baseline, posttest, and 1- and 3-month follow-up.

Full Title of Study: “”Remind to Move” Treatment Versus Constraint-induced Movement Therapy for Children With Hemiplegic Cerebral Palsy: A Randomized Controlled Trial”

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Randomized
    • Intervention Model: Parallel Assignment
    • Primary Purpose: Treatment
    • Masking: Single (Outcomes Assessor)
  • Study Primary Completion Date: September 2015

Interventions

  • Behavioral: Remind-to-move
  • Behavioral: Modified constraint induced movement therapy
  • Behavioral: Conventional rehabilitation

Arms, Groups and Cohorts

  • Experimental: Remind-to-move
    • RTM involved a wristwatch device worn on more-affected arm which emitted sensory cueing continuously to remind the children to use the more-affected hand to engage in daily activities or complete bimanual tasks intensively, 5 hour per day, 5 days every week, for 3 consecutive weeks.
  • Active Comparator: Modified constraint induced movement therapy (mCIMT)
    • children were encouraged to wear a customer-made volar resting splint that extended from below the elbow to the fingertips on their noninvolved hands for 5 hour daily except for toileting, writing and specific physical sports, for 3 weeks. Each child was supervised by one therapist to complete structured unimanual practice with the affected hand during the supervised session, 5 days every week, for 3 consecutive weeks.
  • Placebo Comparator: Conventional rehabilitation
    • Conventional splinting, muscle strengthening, stretching, and neurodevelopmental facilitation techniques for 1hr daily, 2 day per week for 3 weeks.

Clinical Trial Outcome Measures

Primary Measures

  • Jebsen-Taylor Hand Function Test (JTHFT)
    • Time Frame: Change from Baseline at 3 weeks (plus follow up at 1 month and 3 months after training)
  • Bruininks-Oseretsky Test of Motor Proficiency (2nd ed.) (BOTMP-II)
    • Time Frame: Change from Baseline at 3 weeks (plus follow up at 1 month and 3 months after training)

Secondary Measures

  • Caregiver Functional Use Survey (CFUS)
    • Time Frame: Change from Baseline at 3 weeks (plus follow up at 1 month and 3 months after training)
  • Ratio of movement duration on the affected hand from accelerometer
    • Time Frame: Change from Baseline at 3 weeks (plus follow up at 1 month and 3 months after training)
  • Active range of motion (AROM) as measured by digital goniometer
    • Time Frame: Change from Baseline at 3 weeks (plus follow up at 1 month and 3 months after training)
  • Power grip strength as measured by dynamometer
    • Time Frame: Change from Baseline at 3 weeks (plus follow up at 1 month and 3 months after training)

Participating in This Clinical Trial

Inclusion Criteria

  • Diagnosis of Hemiplegic Cerebral Palsy – Aged 5 to 16 years – Ability to follow instructions – Ability to grasp and release light objects, and at least 20° wrist and 10°fingers in metacarpophalangeal joints extension from full flexion for the affected hand – Manual Activity Classification System (MACS) 19 grades I, II or III of the affected hand Exclusion Criteria:

  • Severe cognitive, visual, or auditory disorder – Seizure and health problems not associated with cerebral palsy – Predominant spasticity or contracture grades more than 3 of Modified Ashworth Scale 20 on wrist and finger flexors, forearm pronators and ⁄ or thumb adductors – Receiving new pharmaceutical (i.e. botulinum toxin injections) and/or surgical interventions within 6-month before study

Gender Eligibility: All

Minimum Age: 5 Years

Maximum Age: 16 Years

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • The Hong Kong Polytechnic University
  • Provider of Information About this Clinical Study
    • Principal Investigator: Kenneth N. K. Fong, Associate Professor – The Hong Kong Polytechnic University

References

Fong KN, Jim ES, Dong VA, Cheung HK. 'Remind to move': a pilot study on the effects of sensory cueing treatment on hemiplegic upper limb functions in children with unilateral cerebral palsy. Clin Rehabil. 2013 Jan;27(1):82-9. doi: 10.1177/0269215512448199. Epub 2012 Jul 16.

Dong AQ, Fong NK. Remind to move – A novel treatment on hemiplegic arm functions in children with unilateral cerebral palsy: A randomized cross-over study. Dev Neurorehabil. 2016 Oct;19(5):275-83. doi: 10.3109/17518423.2014.988304. Epub 2014 Dec 30.

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