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Randomized comparison trial of density and context of upper limb intensive group versus individualized occupational therapy for children with unilateral cerebral palsy
Sakzewski, Leanne Miller, Laura Ziviani, Jenny Abbott, David F. Rose, Stephen Macdonell, Richard A. L. Boyd, Roslyn N.
Sakzewski, Leanne
Miller, Laura
Ziviani, Jenny
Abbott, David F.
Rose, Stephen
Macdonell, Richard A. L.
Boyd, Roslyn N.
Abstract
Aim: To determine whether short-term intensive group-based therapy combining modified constraint-induced movement therapy and bimanual therapy ( hybrid-CIMT ) is more effective than an equal total dose of distributed individualized occupational therapy ( standard care ) on upper limb motor and individualized outcomes. Method: Fifty-three children with unilateral cerebral palsy ( 69% males; mean age 7y 10mo, SD 2y 4mo; Manual Ability Classification System level I, n=24; level II, n=23 ) were randomly allocated, and 44 received either hybrid-CIMT ( n=25 ) or standard care ( n=19 ). Standard care comprised six weekly occupational therapy sessions and a 12-week home programme. Outcomes were assessed at baseline, 13 weeks, and 26 weeks after treatment. Results: Groups were equivalent at baseline. Standard care achieved greater gains on satisfaction with occupational performance after intervention ( estimated mean difference −1.2, 95% CI −2.2 to −0.1; p=0.04 ) and Assisting Hand Assessment at 26 weeks ( estimated mean difference 3.1, 95% CI 0.2–6.0; p=0.04 ). Both groups demonstrated significant improvements in dexterity of the impaired upper limb, and bimanual and occupational performance over time. The differences between groups were not clinically meaningful. Interpretation: There were no differences between the two models of therapy delivery. Group-based intensive camps may not be readily available; however, individualized standard care augmented with a home programme may offer an effective alternative but needs to be provided at a sufficient dose.
Keywords
Date
2015
Type
Journal article
Journal
Developmental Medicine and Child Neurology
Book
Volume
57
Issue
6
Page Range
539-547
Article Number
ACU Department
School of Allied Health
Faculty of Health Sciences
Faculty of Health Sciences
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Open Access Status
License
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Controlled