Improvements in bimanual hand function after baby-CIMT in two-year old children with unilateral cerebral palsy: A retrospective study.
Soft-casting the strong arm for two hours a day before age one doubles the chance of good two-hand use at age two.
01Research in Context
What this study did
Nordstrand et al. (2015) looked back at charts of toddlers with unilateral cerebral palsy. Some had worn a soft cast on the good arm for two hours a day before their first birthday. The team checked who could use both hands together at age two.
What they found
Kids who got baby-CIMT were six times more likely to score high on bimanual hand use. Starting the cast early doubled the odds of strong two-hand play.
How this fits with other research
Hung et al. (2013) seems to disagree. They saw older kids with the same diagnosis learn bimanual tasks slower and peak lower than peers. The gap closes when you notice age and method: the 2013 group was preschool age and only practiced, while Linda’s babies got structured casting before twelve months.
Houwink et al. (2011) laid the idea that attention load blocks use of the weak hand. Baby-CIMT gives real-world proof that cutting off the easy arm early pushes the brain to use both sides.
Amore et al. (2011) showed force control stays poor in school-age kids. Linda’s data hint that early casting may prevent some of that lag if you start in infancy.
Why it matters
If you serve babies at risk for hemiplegic CP, talk with the OT about baby-CIMT. Two hours a day of gentle constraint before the first birthday can set up smoother two-hand skills for years. Track bimanual play monthly and share progress with the team.
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02At a glance
03Original abstract
The common assumption that early-onset intensive intervention positively affects motor development has rarely been investigated for hand function in children with unilateral cerebral palsy (CP). This retrospective study explored the possible impact of baby constraint-induced movement therapy (baby-CIMT) on hand function at two years of age. We hypothesized that baby-CIMT in the first year of life would lead to better bimanual hand use at two years of age than would not receiving baby-CIMT. The Assisting Hand Assessment (AHA) was administered at age 21 months (SD 2.4 months) in 72 children with unilateral CP, 31 of who received baby-CIMT. When dividing the children into four functional levels based on AHA, the proportional distribution differed between the groups in favour of baby-CIMT. Logistic regression analysis indicated that children in the baby-CIMT group were more likely than were children in the no baby-CIMT group to have a high functional level, even when controlling for the effect of brain lesion type (OR 5.83, 95% CI 1.44-23.56, p = 0.001). However, no difference was found between groups in the odds of having a very low functional level (OR 0.31, 95% CI 0.08-1.17, p = 0.084). The result shows that baby-CIMT at early age can have a positive effect. Children who received baby-CIMT were six times more likely to have a high functional level at two years of age than were children in the no baby-CIMT group.
Research in developmental disabilities, 2015 · doi:10.1016/j.ridd.2015.05.003