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Rohr L.A.1, Santana C.A.1, Machado L.R.1, Tudella E.1, Santos G.L.1, Silva E.S.M.1
1Universidade Federal de São Carlos, Fisioterapia, São Carlos, Brazil
Background: The motor impairment is one of the main characteristics of children with cerebral palsy, which affects the functional performance. The limitations due to functional impairments affect the activities of daily living, independence and development. The Constraint-Induced Therapy Movement (CIMT) has shown to be effective in reducing the asymmetry of the upper limbs use in children with cerebral palsy with a supposed improvement in the quality of life of children and their families.
Purpose: To verify the effects of CIMT on the functionality and upper limb use in children with hemiparetic cerebral palsy.
Methods: This longitudinal study consists of a several case studies. The study included four children, three boys between 4 and 11 years (average of 90 months, ± 46.36), and one girl with age average of 84 months treated in the Physiotherapy program of Unit Health School of the Federal University of São Carlos, São Paulo - Brazil. All participants were between the levels I and II of GMFCS and level III of Macs. The therapy was performed in the child´s residence for three consecutive weeks with time session of three hours. A synthetic plaster was used in the more-affected limb during 24 hours, which was only removed for cleaning. In the therapy protocol were performed repetitive and progressive training with task-oriented function and behavioral training. The use of the more affected upper limb was evaluated by the Pediatric Upper Extremity scale Motor Activity Log (PMAL), to uni and bilateral functionality of limbs was evaluated by the scale Pediatric Arm Function Test (PAFT) in three times: maximum of seven days before the start of therapy (pre-assessment), 24 hours after the end of therapy (post-assessment), and ten days after the end of therapy (after 10 days).
Results: For PMAL in the pre-assessment, a frequency of 0.80±0.65 and quality of 0.76±0.62 were observed. In the post-assessment, an increase in the frequency values for 3.00 ± 0.96 and 2.96 ± 1.03 for quality were observed. After 10 days, the values of frequency were 3.00±1.03 and quality were 2.94±1.00. Average of unimanual functionality (affected limb) in PAFT was 50.30 ± 1.10 in the pre-assessment; 72.04 ± 15.50 in the post-assessment; and 87.08 ± 5.30 in the post-10 days. For bimanual activities were observed the following averages: 52.15±20.91 in the pre-assessment; 85.50±12.38 in the post-assessment; e 93.30±7.69 in the post-10 days. Thus, for unimanual activities, compared to pre-assessment, an increase of 21.74% and 36.78% was observed in the post-assessment and post-10 days, respectively. For bimanual activities, an increase of 33.55% and 41.15% were observed in the post-assessment and post-10 days, respectively.
Conclusion(s): CIMT can be an intervention that promotes increase in the functionality and upper limb use in more affected limb in children with cerebral palsy.
Implications: The positive results of this study demonstrate that CIMT, using functional protocols and performed in a familiar environment with high intensity, is an effective method for functionality and upper limb use in children with hemiparetic cerebral palsy. Thus, this therapy promotes the activity and participation of these children in society.
Funding acknowledgements: São Paulo Research Foundation-FAPESP.
Topic: Paediatrics
Ethics approval: This research study was approved by Ethical Committe of Universidade Federal de São Carlos ( Nº 1.171.899).
All authors, affiliations and abstracts have been published as submitted.
