Effects of modified constraint-induced movement therapy in virtual environment on upper-limb function in children with spastic hemiparetic cerebral palsy: A randomised controlled trial

Objective: To determine effects of implementing a practice period of modified constraint-induced movement therapy in a virtual environment on upper limb function in children with spastic hemiparetic cerebral palsy. Methods: In a single-blinded, randomised, controlled trial, 32 participants (18 female, 14 male) received 18 hours training in 3 different groups (virtual reality, modified constraint-induced movement therapy, and a combination group). The fourth group was a control group. Training sessions occurred every other day, 3 times per week for 4-week. Each session lasted for 1.5 hours. Assessment sessions were conducted before, after, and 3-month after treatment period using pediatric motor activity log and the speed and dexterity subtest of the bruininks-oseretsky test of motor proficiency. Data analysis was conducted by ANOVA with repeated measures using SPSS 16.0 with alpha levels set at P< 0.05. Results: Significantly higher gains were observed in the combination therapy group for the amount of limb use (mean change, 2.72), quality of movement (mean change, 2.79), and speed and dexterity (mean change, 1.74) at post-test. These gains were maintained at the 3-month follow-up assessment. Conclusions: Modified constraint-induced movement therapy in a virtual environment could be a promising rehabilitation procedure to enhance the benefits of both virtual reality and constraint-induced therapy techniques.