Hemiplegic Cerebral Palsy Clinical Trial
Official title:
Comparison of Constraint-induced Movement Therapy and Its Modified Form on Upper Motor Function Outcomes and Psychosocial Impact in Hemiplegic Cerebral Palsy.
The aim of this research is to compare the effect of classic constraint-induced movement therapy and its modified form on upper extremity motor function outcomes and psychosocial impact in hemiplegic cerebral palsy. Randomized controlled trials with 2-3 weeks follow-up. The sample size is 40. The subjects are divided in two groups, 20 subjects in classical CIMT group and 20 in modified CIMT group. Study duration is of 6 months. Sampling technique applied will be purposive non probability sampling technique. Only 4-12 years individual with hemiplegic cerebral palsy are included. Tools used in the study are Box and Block test, Cerebral palsy (quality of life), Kid Screen 27 and QUEST (quality of upper extremity skill test). Data will be analyzed through SPSS 21.
Cerebral palsy is known as a neurodevelopment disease that begins in the early childhood and
persists throughout the life. In the past, it was a challenge to define the term CP. Many
attempts were made to overcome this. In 1964, definition for cerebral palsy was given that is
still used worldwide. According to that cerebral palsy (CP) is not just the disorder of
posture but movement also and it happens due to lesion or damage of an immature brain. It is
a disorder of human brain that is non-progressive. The main focus of the definition was on
the motor impairment. Cerebral palsy can lead to activity limitation. As CP includes motor
disorders so it encounters disturbances like cognition, sensation, communication, seizures
and behavioral disorder.
The frequency with which CP occurs is of importance as it is the first effort towards its
prevention. It also estimates the supportive services and the medical care that is required
for children with cerebral palsy and also their families. Many studies were conducted to
check the trends of Cerebral Palsy occurrence depending upon the low birth weight.
The definition of cerebral palsy shows that it is just a single disorder infect it is
collection of disorders. Prevalence of cerebral palsy shows that out of 1000 births, there
are 2.0-2.5 children are victims of cp. However in few children, the causes of CP are still
not known. Moreover, the causes need to be discriminated from the risk factors. Prenatal
events are also responsible for CP. Such events may include toxins, maternal infection for
example rubella or brain malformations. One of the prenatal causes is birth asphyxia. A small
ratio of CP can be the result of perinatal causes. 10% cases of cp are result of postnatal
causes. The causes can be accidental or non-accidental. Meningitis is also one of the
postnatal causes.
Out of all types of cerebral palsy, one-third is spastic hemiplegic. Birth trauma can be the
cause of spastic hemiplegia. Researches show that there is more ratio of right hemiplegia
than the left hemiplegia. The most common form of CP that is seen in premature children is
spastic diplegia. In spastic diplegia, spasticity affects lower limbs more than the upper
extremity. Birth asphyxia is seen in children born with the choreo-athetosis.
Traditional hemiplegic patients receive occupational and physical therapy to improve their
functional skills. Constraint induced movement therapy (CIMT) is an approach to treating the
hemiparesis that facilitate use of hemiparetic arm through constraint the unaffected arm.it
has been shown to be effective treatment in hemiparesis in adult and children.
In this study, I hypothesized that there is a difference between the effectiveness of classic
CIMT with modified CIMT on upper extremity motor function outcomes in children with
hemiplegic cerebral palsy. The purpose of this study is to compare the effects of classic
CIMT with modified CIMT on upper extremity motor functions and to see the psychosocial impact
of CIMT on hemiplegic cerebral palsy.
LITERATURE REVIEW:
There is injury of undeveloped brain in Children with CP. Children with hemiplegic cerebral
palsy (HCP) have trouble using their affected arm and hand on one side of their body.
Evidence from randomized controlled trials, clinical controlled trials, and systematic
reviews has shown constraint therapy improves hand and arm movement in children with
hemiplegic cerebral palsy. According to a research review done in 2014; it is seen that CIMT
proved to be beneficial in improving hand function as compared to the conventional therapy. A
comparison was done between equal intensity of bimanual training and CIMT. Results showed
same progress in hand function.
A comparison was done between equal intensity of hand arm bimanual training (HABIT) and CIMT.
Results showed same progress in hand function. Modified constraint-induced movement therapy
improved isolated functions of the hemiplegic arm better than intensive bimanual training,
but regarding spontaneous hand use in everyday life both methods lead to similar improvement.
This suggests mCIMT should be paired with BIT to achieve optimal results for children with
HCP who present with difficulties in both unimanual and bimanual hand functions. A study
combining mCIMT and BIT demonstrated more frequent and more effective use of the affected
limb, and better performance inself-care and leisure tasks.
Children and parents from both groups (CIMT and BIT) reported a significant improvement in
their or their child's feelings about functioning as well as participation and physical
health. The parents of children receiving CIMT reported positive and sustained changes in
their child's social well-being (CPQOL-Child). The CIMT group showed significant improvements
in physical well-being, psychological well-being, moods and emotions.
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