Application of Low-Intensity Modified Constraint-Induced Movement Therapy to Improve the Affected Upper Limb Functionality in Infantile Hemiplegia with Moderate Manual Ability: Case Series
<p>Child with left hemiplegia wearing a bandage as a partial containment in the right hand (dominant hand). In this task, the child is working the grasp–release action.</p> "> Figure 2
<p>Weekly follow-up for the families.</p> "> Figure 3
<p>Representation of the assessment number in the 5 weeks of treatment (mCIMT).</p> "> Figure 4
<p>Grasp strength measurement with a hand dynamometer.</p> "> Figure 5
<p>Flowchart of the sample selection.</p> ">
Abstract
:1. Introduction
2. Materials and Methods
2.1. Intervention Method
2.2. Data Collection
2.2.1. Studied Variables and Measuring Instruments
Quality of Movement and Bimanual Dexterity of Both Upper Extremities
Active Extension of the Wrist and Active Supination of the Forearm in the Affected Upper Limb
Grasp Strength in the Affected Hand
Spontaneous Use, Dynamic Positioning of the Affected Upper Limb, Grasping and Releasing Action (Wrist Position in Neutral Flexion–Extension), and Level of Functionality and Integration of the Affected Upper Limb in Various Activities of Daily Living
2.3. Statistical Analysis
3. Results
3.1. Quality of Movement of the Upper Limb
3.2. Grasp Strength
3.3. Active Elbow Extension and Forearm Supination
3.4. Spontaneous Use, Dynamic Joint Position of the Affected Upper Limb, Grasp and Release Action (Wrist Position in Neutral Flexion–Extension), and Level of Functionality and Integration of the Affected Upper Limb in Different Activities of Daily Living
4. Discussion
Limitations and Future Lines of Research
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Movements to Work in the Affected Upper Limb | Examples of mCIMT Designed Tasks |
---|---|
Shoulder flexion and elbow extension |
|
Forearm supination |
|
Wrist extension |
|
Grasp–release |
|
Dependent | Value 0. Needs help from an adult (does not perform the action). |
Assisted | Value 1. Needs help from an adult (partially performs the action). |
Independent | Value 2. Uses the healthy upper limb exclusively. |
Value 3. Uses the upper limb to provide stability. | |
Value 4. Uses both upper limbs to execute the action. |
Sample | Age | Sex | Gest. Week | Lesion | MACS Level | GMFCS Level | Hemiplegia Side | Add. Impair |
---|---|---|---|---|---|---|---|---|
Child 1 | 4 | F | Term | Perinatal stroke | II | I | Left | No |
Child 2 | 5 | M | Term | Perinatal stroke | II | I | Right | No |
Child 3 | 5 | M | Preterm | Perinatal stroke | II | I | Left | No |
Child 4 | 5 | M | Preterm | Perinatal stroke | II | I | Left | No |
Child 5 | 7 | F | Term | Perinatal stroke | II | I | Right | Speech |
Child 6 | 6 | F | Term | Perinatal stroke | II | I | Right | Speech |
Child 7 | 8 | F | Preterm | Perinatal stroke | II | I | Left | Speech |
Child 8 | 8 | M | Term | Perinatal stroke | II | I | Left | No |
Variables | Results | Friedman’s Test | Wilcoxon’s Test | |||
---|---|---|---|---|---|---|
Median (IQR) | Statistical Significance | p Value | Pairwise Comparisons | Statistical Significance | p Value | |
Quality of Movement in the Upper Limbs (Total Score) | ||||||
Baseline | 74.16 (63.55, 83.00) | 24.000 | 0.000 * | Baseline–2nd assessment | −2.521 | 0.012 * |
2nd assessment | 83.32 (77.18, 88.49) | Baseline–3rd assessment | −2.521 | 0.012 * | ||
3rd assessment | 88.70 (84.42, 91.42) | Baseline–4th assessment | −2.521 | 0.012 * | ||
4th assessment | 94.07 (90.32, 94.92) | 2nd assessment–3rd assessment | −2.521 | 0.012 * | ||
2nd assessment–4th assessment | −2.521 | 0.012 * | ||||
3rd assessment–4th assessment | −2.521 | 0.012 * | ||||
Dissociated Movements | ||||||
Baseline | 59.38 (53.90, 80.48) | 23.538 | 0.000 * | Baseline–2nd assessment | −2.524 | 0.012 * |
2nd assessment | 75.00 (73.83, 82.82) | Baseline–3rd assessment | −2.521 | 0.012 * | ||
3rd assessment | 83.60 (81.24, 87.11) | Baseline–4th assessment | −2.521 | 0.012 * | ||
4th assessment | 89.84 (84.77, 91.79) | 2nd assessment–3rd assessment | −2.201 | 0.028 * | ||
2nd assessment–4th assessment | −2.524 | 0.012 * | ||||
3rd assessment–4th assessment | −2.527 | 0.012 * | ||||
Grasp | ||||||
Baseline | 62.97 (46.30, 76.86) | 21.808 | 0.000 * | Baseline–2nd assessment | −2.533 | 0.011 * |
2nd assessment | 79.60 (59.26, 87.96) | Baseline–3rd assessment | −2.527 | 0.012 * | ||
3rd assessment | 87.03 (63.89, 91.67) | Baseline–4th assessment | −2.527 | 0.012 * | ||
4th assessment | 96.30 (75.00, 96.30) | 2nd assessment–3rd assessment | −2.200 | 0.028 * | ||
2nd assessment–4th assessment | −2.384 | 0.017 * | ||||
3rd assessment–4th assessment | −2.384 | 0.017 * | ||||
Weight Bearing | ||||||
Baseline | 87.00 (76.50, 93.50) | 19.154 | 0.000 * | Baseline–2nd assessment | −2.536 | 0.011 * |
2nd assessment | 98.00 (85.50, 99.50) | Baseline–3rd assessment | −2.524 | 0.012 * | ||
3rd assessment | 97.00 (93.00, 99.50) | Baseline–4th assessment | −2.521 | 0.012 * | ||
4th assessment | 99.00 (96.00, 100.00) | 2nd assessment–3rd assessment | −1.461 | 0.144 | ||
2nd assessment–4th assessment | −1.461 | 0.102 | ||||
3rd assessment–4th assessment | −1.604 | 0.109 | ||||
Protective Extension | ||||||
Baseline | 80.56 (75.00, 90.27) | 17.431 | 0.001 * | Baseline–2nd assessment | −1.841 | 0.066 |
2nd assessment | 83.34 (79.17, 96.53) | Baseline–3rd assessment | −2.207 | 0.027 * | ||
3rd assessment | 90.27 (84.73, 97.92) | Baseline–4th assessment | −2.379 | 0.017 * | ||
4th assessment | 94.44 (92.36, 99.31) | 2nd assessment–3rd assessment | −1.826 | 0.068 | ||
2nd assessment–4th assessment | −2.207 | 0.027 * | ||||
3rd assessment–4th assessment | −2.023 | 0.043 * |
Variable: Grasp Strength | Results | Friedman Test | Wilcoxon Test | |||
---|---|---|---|---|---|---|
Median (IQR) | Statistical Significance | p Value | Pairwise Comparisons | Statistical Significance | p Value | |
Baseline | 2.00 (1.00, 2.75) | 20.069 | 0.000 * | Baseline–2nd assessment | 0.000 | 1.000 |
2nd assessment | 2.00 (1.00, 2.75) | Baseline–3rd assessment | −2.000 | 0.046 * | ||
3rd assessment | 2.00 (1.25, 3.75) | Baseline–4th assessment | −2.640 | 0.008 * | ||
4th assessment | 3.00 (2.25, 4.50) | 2nd assessment–3rd assessment | −2.000 | 0.046 * | ||
2nd assessment–4th assessment | −2.640 | 0.008 * | ||||
3rd assessment–4th assessment | −2.449 | 0.014 * |
Variables: Active Elbow Extension | Results | Friedman Test | Wilcoxon Test | |||
---|---|---|---|---|---|---|
Median (IQR) | Statistical Significance | p Value | Pairwise Comparisons | Statistical | p Value | |
Baseline | 12.50 (10.00, 43.75) | 23.423 | 0.000 * | Baseline–2nd assessment | −2.565 | 0.010 * |
2nd assessment | 22.50 (20.00, 50.00) | Baseline–3rd assessment | −2.533 | 0.011 * | ||
3rd assessment | 27.50 (22.75, 54.50) | Baseline–4th assessment | −2.536 | 0.011 * | ||
4th assessment | 33.50 (25.75, 64.25) | 2nd Assessment–3rd assessment | −2.456 | 0.014 * | ||
2nd assessment–4th assessment | −2.536 | 0.011 * | ||||
3rd assessment–4th assessment | −2.375 | 0.018 * | ||||
Active Forearm Supination | ||||||
Baseline | 70.00 (35.50, 75.00) | 23.416 | 0.000 * | Baseline–2nd assessment | −2.588 | 0.010 * |
2nd assessment | 75.00 (45.00, 80.00) | Baseline–3rd assessment | −2.536 | 0.011 * | ||
3rd assessment | 76.50 (53.50, 82.25) | Baseline–4th assessment | −2.524 | 0.012 * | ||
4th assessment | 81.50 (58.75, 87.75) | 2nd Assessment–3rd assessment | −2.032 | 0.042 * | ||
2nd assessment–4th assessment | −2.536 | 0.011 * | ||||
3rd assessment–4th assessment | −2.527 | 0.012 * |
Variable | Results | Friedman’s Test | Wilcoxon’s Test | |||
---|---|---|---|---|---|---|
Spontaneous Use in the Affected Upper Limb | Median (IQR) | Statistical Significance | p Value | Pairwise Comparisons | Statistical Significance | p Value |
Baseline | 70.00 (49.45, 87.78) | 18.932 | 0.000 * | Baseline–2nd assessment | −2.371 | 0.018 * |
2nd assessment | 85.56 (58.34, 95.00) | Baseline–3rd assessment | −2.366 | 0.018 * | ||
3rd assessment | 87.78 (72.78, 95.55) | Baseline–4th assessment | −2.521 | 0.012 * | ||
4th assessment | 88.87 (87.11, 97.22) | 2nd assessment–3rd assessment | −2.201 | 0.028 * | ||
2nd assessment–4th assessment | −1.963 | 0.050 | ||||
3rd assessment–4th assessment | −1.690 | 0.091 | ||||
Dynamic Joint Position | ||||||
Baseline | 77.78 (48.24, 86.81) | 23.416 | 0.000 * | Baseline–2nd assessment | −2.366 | 0.018 * |
2nd assessment | 80.56 (75.35, 89.93) | Baseline–3rd assessment | −2.521 | 0.012 * | ||
3rd assessment | 85.44 (71.87, 9132) | Baseline–4th assessment | −2.521 | 0.012 * | ||
4th assessment | 88.20 (84.03, 92.71) | 2nd assessment–3rd assessment | −1.183 | 0.237 | ||
2nd assessment–4th assessment | −2.366 | 0.018 * | ||||
3rd assessment–4th assessment | −2.023 | 0.043 * | ||||
Grasp–Release action | ||||||
Baseline | 58.34 (50.00, 91.67) | 13.568 | 0.004 * | Baseline–2nd assessment | −1.414 | 0.157 |
2nd assessment | 75.00 (54.17, 95.83) | Baseline–3rd assessment | −1.890 | 0.059 | ||
3rd assessment | 83.33 (66.67, 100.00) | Baseline–4th assessment | −2.226 | 0.026 * | ||
4th assessment | 91.67 (83.33, 100.00) | 2nd assessment–3rd assessment | −1.342 | 0.180 | ||
2nd assessment–4th assessment | −2.041 | 0.041 * | ||||
3rd assessment–4th assessment | −1.857 | 0.063 |
Variable | Results | Friedman’s Test | Wilcoxon’s Test | |||
---|---|---|---|---|---|---|
Upper Limb Dressing | Median (IQR) | Statistical Significance | p Value | Pairwise Comparisons | Statistical Significance | p Value |
Baseline | 3.50 (2.25, 4.00) | 10.355 | 0.016 * | Baseline–2nd assessment | 0.000 | 1.000 |
2nd assessment | 3.50 (2.25, 4.00) | Baseline–3rd assessment | −1.633 | 0.102 | ||
3rd assessment | 4.00 (3.25, 4.00) | Baseline–4th assessment | −1.857 | 0.063 | ||
4th assessment | 4.00 (4.00, 4.00) | 2nd assessment–3rd assessment | −1.633 | 0.102 | ||
2nd assessment–4th assessment | −1.857 | 0.063 | ||||
3rd assessment–4th assessment | −1.414 | 0.157 | ||||
Lower Limb Dressing | ||||||
Baseline | 3.00 (2.25, 3.00) | 15.245 | 0.002 * | Baseline–2nd assessment | −1.414 | 0.157 |
2nd assessment | 3.00 (3.00, 3.75) | Baseline–3rd assessment | −2.000 | 0.046 * | ||
3rd assessment | 3.00 (3.00, 4.00) | Baseline–4th assessment | −2.530 | 0.011 * | ||
4th assessment | 4.00 (4.00, 4.00) | 2nd assessment–3rd assessment | −1.414 | 0.157 | ||
2nd assessment–4th assessment | −2.449 | 0.014 * | ||||
3rd assessment–4th assessment | −2.000 | 0.046 * | ||||
Putting on Splints | ||||||
Baseline | 3.00 (1.00, 3.75) | 9.923 | 0.019 * | Baseline–2nd assessment | 0.000 | 1.000 |
2nd assessment | 3.00 (1.00, 3.75) | Baseline–3rd assessment | −1.633 | 0.102 | ||
3rd assessment | 3.00 (1.00, 4.00) | Baseline–4th assessment | −1.857 | 0.063 | ||
4th assessment | 4.00 (1.50, 4.00) | 2nd assessment–3rd assessment | −1.633 | 0.102 | ||
2nd assessment–4th assessment | −1.857 | 0.063 | ||||
3rd assessment–4th assessment | −1.414 | 0.157 | ||||
Putting on Shoes | ||||||
Baseline | 2.00 (2.00, 3.50) | 15.188 | 0.002 * | Baseline–2nd assessment | −1.000 | 0.317 |
2nd assessment | 2.00 (2.00, 3.75) | Baseline–3rd assessment | −2.121 | 0.034 * | ||
3rd assessment | 3.00 (3.00, 4.00) | Baseline–4th assessment | −2.271 | 0.023 * | ||
4th assessment | 4.00 (3.25, 4.00) | 2nd assessment–3rd assessment | −1.890 | 0.059 | ||
2nd assessment–4th assessment | −2.251 | 0.024 * | ||||
3rd assessment–4th assessment | −1.633 | 0.102 | ||||
Putting on Socks | ||||||
Baseline | 3.00 (3.00, 3.75) | 15.000 | 0.002 * | Baseline–2nd assessment | 0.000 | 1.000 |
2nd assessment | 3.00 (3.00, 3.75) | Baseline–3rd assessment | −2.000 | 0.046 * | ||
3rd assessment | 3.00 (3.00, 4.00) | Baseline–4th assessment | −2.333 | 0.020 * | ||
4th assessment | 4.00 (4.00, 4.00) | 2nd assessment–3rd assessment | −2.000 | 0.046 * | ||
2nd assessment–4th assessment | −2.333 | 0.020 * | ||||
3rd assessment–4th assessment | −1.732 | 0.083 | ||||
Buttoning Up | ||||||
Baseline | 1.00 (0.00, 3.00) | 5.118 | 0.163 | Baseline–2nd assessment | −1.000 | 0.317 |
2nd assessment | 1.50 (0.00, 3.00) | Baseline–3rd assessment | −1.414 | 0.157 | ||
3rd assessment | 1.50 (0.00, 3.75) | Baseline–4th assessment | −1.342 | 0.180 | ||
4th assessment | 1.50 (0.00, 4.00) | 2nd assessment–3rd assessment | −1.000 | 0.317 | ||
2nd assessment–4th assessment | −1.414 | 0.157 | ||||
3rd assessment–4th assessment | −1.000 | 0.317 | ||||
Personal Hygiene | ||||||
Baseline | 2.00 (2.00, 2.00) | 15.000 | 0.002 * | Baseline–2nd assessment | 0.000 | 1.000 |
2nd assessment | 2.00 (2.00, 2.00) | Baseline–3rd assessment | −1.890 | 0.059 | ||
3rd assessment | 2.50 (2.00, 4.00) | Baseline–4th assessment | −2.333 | 0.020 * | ||
4th assessment | 4.00 (2.25, 4.00) | 2nd assessment–3rd assessment | −1.890 | 0.059 | ||
2nd assessment–4th assessment | −2.333 | 0.020 * | ||||
3rd assessment–4th assessment | −1.633 | 0.102 |
© 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
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Palomo-Carrión, R.; Romero-Galisteo, R.-P.; Pinero-Pinto, E.; López-Muñoz, P.; Romay-Barrero, H.; José, F.G.-M.S. Application of Low-Intensity Modified Constraint-Induced Movement Therapy to Improve the Affected Upper Limb Functionality in Infantile Hemiplegia with Moderate Manual Ability: Case Series. Children 2020, 7, 127. https://doi.org/10.3390/children7090127
Palomo-Carrión R, Romero-Galisteo R-P, Pinero-Pinto E, López-Muñoz P, Romay-Barrero H, José FG-MS. Application of Low-Intensity Modified Constraint-Induced Movement Therapy to Improve the Affected Upper Limb Functionality in Infantile Hemiplegia with Moderate Manual Ability: Case Series. Children. 2020; 7(9):127. https://doi.org/10.3390/children7090127
Chicago/Turabian StylePalomo-Carrión, Rocío, Rita-Pilar Romero-Galisteo, Elena Pinero-Pinto, Purificación López-Muñoz, Helena Romay-Barrero, and Francisco García-Muro San José. 2020. "Application of Low-Intensity Modified Constraint-Induced Movement Therapy to Improve the Affected Upper Limb Functionality in Infantile Hemiplegia with Moderate Manual Ability: Case Series" Children 7, no. 9: 127. https://doi.org/10.3390/children7090127
APA StylePalomo-Carrión, R., Romero-Galisteo, R. -P., Pinero-Pinto, E., López-Muñoz, P., Romay-Barrero, H., & José, F. G. -M. S. (2020). Application of Low-Intensity Modified Constraint-Induced Movement Therapy to Improve the Affected Upper Limb Functionality in Infantile Hemiplegia with Moderate Manual Ability: Case Series. Children, 7(9), 127. https://doi.org/10.3390/children7090127