Constraint-Fact or Fiction? Comparison of Different Methods of Constraint with No Constraint in Upper Limb Function in Moderately Spastic Hemiplegic Cerebral Palsy Children

Background: Children with hemiplegic Cerebral Palsy often fail to use the involved upper extremity and learn to perform most tasks exclusively with their non involved upper extremity. The aim of the present study is to probe the constraint component of the dichotomy by comparing the effects of most invasive, least invasive and no constraint in improving affected upper limb functions in hemiplegic cerebral palsy children. Method: Subjects of 3-8 years are coming at Pt. D. D. U. I. P. H., Delhi University, New Delhi was included between August and December 2009. The selected subjects were assigned randomly into 3 groups i.e. (least invasive) m CIMT, (most invasive) CIMT, and no CIMT and it was initially assessed by using the Quality of Upper Extremity Skills Test (QUEST)to obtain baseline scores 1-3 days before start of therapy. Subjects were treated by m CIMT (LI) with gentle holding and CIMT (MI) with splint and no CIMT (NC) with no restrain for 2 days/week (1 hr/day) for a total of 8 days over 4 weeks. Results: Baseline comparison of mean ranks was done before treatment which was found to be insignificant (p=.795) showing that there was no significant difference between the pre QUEST scores of the subjects in the three groups before treatment. Post treatment the mean ranks of all the three groups showed a statistically significant difference (p=.000) with mean rank for the mCIMT group to be the highest. Conclusions: The findings of this study reveal that the mCIMT is more effective than CIMT in children with hemiplegic cerebral palsy as the method of restraint in mCIMT is well tolerated than CIMT by children and little frustration is there due to constraint on unaffected extremity. Moreover, this type of restraint is cost-effective and easy to use than any other method.