Combining constraint-induced movement therapy and action-observation training in children with unilateral cerebral palsy: A randomized controlled trial

Cristina Simon-Martinez, Lisa Mailleux, Els Ortibus, Anna Fehrenbach, Giuseppina Sgandurra, Giovanni Cioni, Kaat Desloovere, Nicole Wenderoth, Philippe Demaerel, Stefan Sunaert, Guy Molenaers, Hilde Feys, Katrijn Klingels

Research output: Contribution to journalArticle

Abstract

Background: Upper limb (UL) deficits in children with unilateral cerebral palsy (uCP) have traditionally been targeted with motor execution treatment models, such as modified Constraint-Induced Movement Therapy (mCIMT). However, new approaches based on a neurophysiological model such as Action-Observation Training (AOT) may provide new opportunities for enhanced motor learning. The aim of this study is to describe a randomised controlled trial (RCT) protocol investigating the effects of an intensive treatment model, combining mCIMT and AOT compared to mCIMT alone on UL function in children with uCP. Additionally, the role of neurological factors as potential biomarkers of treatment response will be analysed. Methods: An evaluator-blinded RCT will be conducted in 42 children aged between 6 and 12years. Before randomization, children will be stratified according to their House Functional Classification Scale, age and type of corticospinal tract wiring. A 2-weekday-camp will be set up in which children receive intensive mCIMT therapy for 6 hours a day on 9 out of 11 consecutive days (54h) including AOT or control condition (15h). During AOT, these children watch video sequences showing goal-directed actions and subsequently execute the observed actions with the more impaired UL. The control group performs the same actions after watching computer games without human motion. The primary outcome measure will be the Assisting Hand Assessment. Secondary outcomes comprise clinical assessments across body function, activity and participation level of the International Classification of Function, Disability and Health. Furthermore, to quantitatively evaluate UL movement patterns, a three-dimensional motion analysis will be conducted. UL function will be assessed at baseline, immediately before and after intervention and at 6months follow up. Brain imaging comprising structural and functional connectivity measures as well as Transcranial Magnetic Stimulation (TMS) to evaluate corticospinal tract wiring will be acquired before the intervention. Discussion: This paper describes the methodology of an RCT with two main objectives: (1) to evaluate the added value of AOT to mCIMT on UL outcome in children with uCP and (2) to investigate the role of neurological factors as potential biomarkers of treatment response.

Original languageEnglish
Article number250
JournalBMC Pediatrics
Volume18
Issue number1
DOIs
Publication statusPublished - Jul 31 2018

Keywords

  • Brain injuries
  • Intensive therapy
  • Neuroimaging
  • Treatment outcome
  • Unilateral cerebral palsy
  • Upper extremity

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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    Simon-Martinez, C., Mailleux, L., Ortibus, E., Fehrenbach, A., Sgandurra, G., Cioni, G., Desloovere, K., Wenderoth, N., Demaerel, P., Sunaert, S., Molenaers, G., Feys, H., & Klingels, K. (2018). Combining constraint-induced movement therapy and action-observation training in children with unilateral cerebral palsy: A randomized controlled trial. BMC Pediatrics, 18(1), [250]. https://doi.org/10.1186/s12887-018-1228-2