Therapy has long-lasting benefits for children with cerebral palsy

A therapist works with a young girl with hemiparetic cerebral palsy to improve the motor skills on her impaired side. Virginia Tech

Cerebral palsy is a group of disorders that affect movement, muscle coordination, and balance. They involve the part of the brain that controls muscle movements. Most of those with cerebral palsy have brain damage prior to birth or shortly thereafter, although signs may not appear until late in the first year of life. It can cause problems with balance and coordination, problems walking, and muscle tone.

There is no cure for cerebral palsy, but early treatment can help. Children with hemiparetic cerebral palsy, who are only affected on one side of their body, are now sometimes treated with forms of a physical therapy known as constraint-induced movement therapy (CIMT). However, its availability is limited and treatment protocols vary.

CIMT is designed to improve arm and hand function. In it, a child’s better functioning arm is restricted with a cast or splint to help promote use of the affected arm and hand. A trained therapist then provides structured activities to encourage motor control and functional skills in the impaired arm and hand.

Questions remained about the amount of CIMT needed and whether the constraints should be worn continuously or only during treatment sessions. To address these questions, a team led by Dr. Sharon Landesman Ramey of Virginia Tech conducted a randomized controlled trial of CIMT compared to usual treatment.

The study included 118 children, ages 2 to 8 years old, with hemiparetic cerebral palsy. Children were randomly assigned to a control group, which received conventional forms of rehabilitation therapy, or one of four treatment groups: high or moderate doses of CIMT with either a lightweight, full-arm cast worn continuously or a part-arm splint worn just during treatment sessions.

The study was funded by NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). Results were published in Pediatrics on November 1, 2021.

The children received CIMT therapy at home over four weeks. The “high” dose group received three-hour sessions five days per week (60 hours total). The “moderate” group had 2.5-hour sessions three days per week (30 hours total). Trained therapists also worked with the families to develop a post-treatment plan. The research team evaluated measures of hand and arm function at the start of the study, after treatment, and six months later. The assessments were “blinded,” meaning the researchers did not know which treatment the children had received. Parents also rated their children’s progress.

The children in the high-dose group had the greatest skill improvement. This included greater ability to move the arm and hand, as well as improvements in reaching, grasping, and manipulating objects. High-dose CIMT produced the greatest gains both after treatment and six months later, regardless of whether a full-time cast or part-time splint was used.

Unexpectedly, children in the control group also improved on many objective measures. The team found that these children received a higher dose of usual therapy than seen in past studies. The finding suggests that the dosage therapists normally use may have increased over time.

Overall, these findings suggest that high-dose CIMT—with either a temporary splint or a full-time cast—led to the greatest skill gains among children with hemiparetic cerebral palsy.

“[The study] provides new findings that are practically useful for clinicians and families in choosing treatment likely to produce meaningful benefits for children with hemiparetic cerebral palsy,” Ramey says.