Motor learning curve and long-term effectiveness of modified constraint-induced movement therapy in children with unilateral cerebral palsy: a randomized controlled trial.

The goal of this study was to determine the progression of manual dexterity during 6 weeks (54h) (modified) constraint-induced movement therapy ((m)CIMT) followed by 2 weeks (18h) bimanual training (BiT) in children with unilateral spastic cerebral palsy (CP), to establish whether and when a maximal training effect was reached and which factors might influence the motor learning curve. In addition, long-term retention of effects was determined. In a randomized controlled trial of 52 children with CP, aged 2.5-8 years, comparing mCIMT-BiT to conventional therapy, 28 children were allocated to the mCIMT-BiT group. This group was assessed weekly with the Box and Block test. Long-term effectiveness was determined by collecting follow-up data of the primary (Assisting Hand Assessment, ABILHAND-Kids) and secondary (Melbourne, COPM) outcomes at six months and one year after intervention. Fifteen children (53.6%) reached a maximum training effect within the mCIMT period. This group differed from others with respect to age, but not gender, affected side or manual ability. Children younger than five years had a greater chance to reach a maximum score within 6 weeks mCIMT (OR=6.67, 95%CI=1.24-35.71) that stabilized already after four weeks; older children showed a longer progression and tended to decline afterwards. In both age groups, beneficial effects were retained in the long term. The findings suggest that children of 5 years and older might profit from a longer period of mCIMT than 54h to reach their maximum unimanual capacity and to retain this capacity during subsequent bimanual training.