Comparative effects of kinect-based versus therapist-based constraint-induced movement therapy on motor control and daily motor function in children with unilateral cerebral palsy: a randomized control trial

Abstract

Background: Constraint-induced movement therapy (CIMT) is a prominent neurorehabilitation approach for improving affected upper extremity motor function in children with unilateral cerebral palsy (UCP). However, the restraint of the less-affected upper extremity and intensive training protocol during CIMT may decrease children's motivation and increase the therapist's workload and family's burden. A kinect-based CIMT program, aiming to mitigate the concerns of CIMT, has been developed. The preliminary results demonstrated that this program was child-friendly and feasible for improving upper extremity motor function. However, whether the kinect-based CIMT can achieve better or at least comparable effects to that of traditional CIMT (i.e., therapist-based CIMT) should be further investigated. Therefore, this study aimed to compare the effects of kinect-based CIMT with that of therapist-based CIMT on upper extremity and trunk motor control and on daily motor function in children with UCP.

Methods: Twenty-nine children with UCP were recruited and randomly allocated to kinect-based CIMT (n = 14) or therapist-based CIMT (n = 15). The intervention dosage was 2.25 h a day, 2 days a week for 8 weeks. Outcome measures, namely upper extremity and trunk motor control and daily motor function, were evaluated before and after 36-h interventions. Upper extremity and trunk motor control were assessed with unimanual reach-to-grasp kinematics, and daily motor function was evaluated with the Revised Pediatric Motor Activity Log. Between-group comparisons of effectiveness on all outcome measures were analyzed by analysis of covariance (α = 0.05).

Results: The two groups demonstrated similar improvements in upper extremity motor control and daily motor function. In addition, the kinect-based CIMT group demonstrated greater improvements in trunk motor control than the therapist-based CIMT group did (F(1,28) > 4.862, p < 0.036).

Conclusion: Kinect-based CIMT has effects comparable to that of therapist-based CIMT on UE motor control and daily motor function. Moreover, kinect-based CIMT helps decrease trunk compensation during reaching in children with UCP. Therefore, kinect-based CIMT can be used as an alternative approach to therapist-based CIMT.

Trial registration: ClinicalTrials.gov Identifier: NCT02808195. Registered on 2016/06/21, https://clinicaltrials.gov/ct2/show/NCT02808195 .

Keywords: Cerebral palsy; Children; Constraint-induced therapy; Upper extremity; Virtual reality.

Fig. 1

Consolidated Standards of Reporting Trials (CONSORT) flowchart. CIMT constraint-induced movement therapy

Fig. 2

Between-group comparisons of upper extremity motor control and daily motor function analyzed by ANCOVAs using baseline scores as the covariate. For each outcome measure, the white bar represents the baseline score, and the black bar represents the posttreatment score. Whiskers represent standard deviations. CIMT constraint-induced movement therapy, RT reaction time, MT movement time, MU movement units, PV peak velocity, PPV percentage of MT when PV occurred, PMAL-R Revised Pediatric Motor Activity Log

Fig. 3

Between-group comparisons of trunk motor control analyzed by ANCOVAs using baseline scores as the covariate. For each outcome measure, the white bar represents the baseline score, and the black bar represents the posttreatment score. Whiskers represent standard deviations. Asterisks represent significant between-group posttreatment differences (p < 0.05). CIMT constraint-induced movement therapy, PPV percentage of movement time when peak velocity occurred, nED normalized endpoint displacement, nTD normalized trunk displacement, TCS Trunk contribution slope