Feasibility of family-directed home-based bimanual intensive therapy combined with modified constraint induced movement therapy (h-BITmCI) in very low and low bimanual functional level: A brief report

Rocío Palomo-Carrión; Helena Romay-Barrero; Cristina Lirio-Romero; Rubén Arroyo-Fernádez; Marta M-Guijarro-Herraiz; Asunción Ferri-Morales

doi:10.1080/17518423.2022.2099993

Feasibility of family-directed home-based bimanual intensive therapy combined with modified constraint induced movement therapy (h-BITmCI) in very low and low bimanual functional level: A brief report

Dev Neurorehabil. 2023 Jan;26(1):63-70. doi: 10.1080/17518423.2022.2099993. Epub 2022 Jul 14.

Authors

Rocío Palomo-Carrión^{1

2}, Helena Romay-Barrero¹, Cristina Lirio-Romero^{1

2}, Rubén Arroyo-Fernádez¹, Marta M-Guijarro-Herraiz³, Asunción Ferri-Morales¹

Affiliations

¹ Nursing, Physiotherapy and Occupational Therapy, Faculty of Physiotherapy, University of Castilla-La Mancha, Toledo, Spain.
² Group of research in Physiotherapy, Faculty of Physiotherapy and Nursing, Toledo, Spain.
³ Nursing, Physiotherapy and Occupational Therapy, Faculty of Nursing, University of Castilla-La Mancha, Cuenca, Spain.

PMID: 35833864
DOI: 10.1080/17518423.2022.2099993

Abstract

Objective: To examine the feasibility of a home-based hybrid Bimanual-Intensive-Therapy combined with modified Constraint-Induced-Movement-Therapy (h-BITmCI) in children with spastic unilateral cerebral palsy (SUCP) with low and very low bimanual functional level.

Methods: A single-group of 10 children aged 5-8 years old, performed the hybrid home Bimanual-Intensive-Therapy (BIT, 80 hours) combined with modified Constraint-Induced-Movement-Therapy (mCIMT, 20 hours): h-BITmCI. Thus, Bimanual Functional Performance (BFP), Quality of Life (QoL) and expectations from families were measured through the Assisting Hand Assessment, (AHA), Pediatric Quality of Life Inventory, for Cerebral Palsy, (PedsQL^TM v. 3.0, CP) and a specific questionnaire for families for baseline period (week 0), during the treatment phase (week 4 and week 8) and after the intervention (week 10). Repeated measures ANOVA analysis (with post hoc test correction) was used for the BFP and QoL, with a confidence interval (CI) of 95% and with p value <.008 considered statistically significant.

Results: Ten children completed the study with an average of 77-hours-BIT and 17-hours-mCIMT. None of the participants dropped out of the study during the follow-up process, and the parents' expectations were fulfilled, indicating high caregiver compliance. During the first 80 hours of BIT, a mean increase of 3.7 AHA units was obtained for the BFP (p = 1.00) and 1.64 points in the QoL (p = 1.00). Clinically relevant changes were observed in the last two weeks (20 hours mCIMT) with a mean increase of 10.6 AHA units in BFP and 6.29 points in QoL (p < .001).

Conclusions: h-BITmCI protocol is feasible to be performed at home with the family's involvement, obtaining the greatest improvements after 100 hours of both therapies. Thus, mCIMT would be a relevant condition to increase the affected upper limb functionality, rather than the dosage used to obtain clinically relevant changes.

Keywords: Infantile hemiplegia; family; feasibility; home-based therapy; intensive therapy; upper extremity.

MeSH terms

Cerebral Palsy*
Child
Child, Preschool
Feasibility Studies
Humans
Physical Therapy Modalities
Quality of Life*
Treatment Outcome
Upper Extremity