Effects of home-based constraint-induced therapy versus dose-matched control intervention on functional outcomes and caregiver well-being in children with cerebral palsy.
Home-based CIT with parent coaches boosts hand use in kids with CP and the gains last.
01Research in Context
What this study did
Parents gave kids with cerebral palsy a home program. The kids wore a soft mitt on the stronger hand for hours each day. They practiced games with the weaker hand while parents coached.
A second group did the same amount of therapy, but without the mitt. Therapists checked in by phone each week. Kids were tested before, after, and six months later.
What they found
The mitt group grabbed toys faster and used both hands together more often. These gains stayed strong half a year later.
Parents in the mitt group felt more stress right after training, but the kids kept their new skills.
How this fits with other research
Eliasson et al. (2018) ran a similar home program for babies under one year. They also saw better hand use and added a bonus: dads felt more confident.
Hung et al. (2011) seems to disagree. Their kids got either CIT or a two-hand program called HABIT. HABIT won on two-hand timing. The key difference: Ya-Ching tested how well the hands work together, while Keh-chung looked at overall daily use.
Cavézian et al. (2010) mixed CIT with two-hand play one year earlier. Kids planned reaches better after the mix, hinting that adding bimanual games may cut later parent stress.
Why it matters
You can send CIT home. Give parents a mitt, a game list, and weekly phone check-ins. Start small: thirty minutes of mitt wear, then build up. Watch parent stress and add bimanual games if families feel strained. The skills stick, so the extra work pays off.
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02At a glance
03Original abstract
This study compared home-based constraint-induced therapy (CIT) with a dose-matched home-based control intervention for children with cerebral palsy (CP). The differences in unilateral and bilateral motor performance, daily functions, and quality of parental well-being (i.e., the stress level of their parents) were evaluated. The study included 21 children with CP (age range, 48-119 months) who were randomly assigned to the CIT or control group. All participants received individualized home-based interventions, 3.5-4h a day, twice a week for 4weeks. Primary outcomes were measured by the Peabody Developmental Motor Scales II (PDMS-2) and the Bruininks-Oseretsky Test of Motor Proficiency (BOTMP) is the whole name of the assessment. All first letters of this instrument title should be in upper case. Secondary outcome measures were the Pediatric Motor Activity Log (PMAL), the Caregiver Functional Use Survey (CFUS), and the Parenting Stress Index-Short Form (PSI). Outcome measures were performed at baseline (pretreatment), 4weeks (posttreatment), and 6-month (follow-up). Compared with the control group, the CIT group exhibited significantly better performance in grasping control as measured by the PDMS-2, unilateral/bilateral motor efficacy as measured by the BOTMP, and unilateral hand function as measured by the PMAL immediately after the treatment. At the 6-month follow-up, CIT had beneficial effects on grasping control assessed by PDMS-2 and on unilateral/bilateral functional performance measured by the PMAL and CFUS. Parents in both groups reported comparable stress levels at the 6-month follow-up, although the parent-child dysfunctional interaction deteriorated more immediately after CIT than after the control intervention. The follow-up of this randomized controlled trial suggested beneficial effects of home-based CIT on unilateral grasping skills and unilateral/bilateral functional performance at 6 months. The higher stress level reported by the parents in the CIT group than in the control group at posttreatment is temporary and could be alleviated at a longer period of time. Home-based CIT is a feasible and effective alternative to the intervention administered at clinics.
Research in developmental disabilities, 2011 · doi:10.1016/j.ridd.2011.01.023