Intervention bimanual stimulates the abilities in infants with asymmetry

The cerebral palsy and brachial plexus injury may cause asymmetry in the use of the upper limbs (UL). This condition requires early treatment to reduce the impact of the child's life; therefore, several proposed interventions aim to increase their functional independence. The Constraint-Induced Movement Therapy (CIMT) and Hand-Arm Bimanual Intensive Therapy (HABIT) have been widely considered effective interventions to improve hand function.

Objective:

Investigate the effects of an intervention protocol based on the CIMT and HABIT theoretical foundations in the stimulation of manual function in infants with the UL asymmetry.

Methods:

Five infants (6-24 months) participated in the study. To evaluate the motor function of infants we used Pediatric Motor Activity Log (PMAL-R) and Manual Function Evaluation (AMIGO), and to assess the caregiver's perception of the participation of the infant in daily tasks, we used the Pediatric Disability Assessment Inventory (PEDI). All evaluations occurred before, immediately after the intervention, and after four months for follow-up recording, and were analyzed descriptively by Jacobson- Truax method.

Results:

The results between evaluation and reevaluation demonstrated evolution in all aspects studied. In the PEDI self-care session, an average of 38.6 (±8.4) - 44.2 (±7.4); PEDI Mobility: 28.8 (±20.3) - 36.28 (±21.7); PEDI Social Function: 40.1 (±10.2) - 42.3 (±8.9). The PMAL-R quantity and quality results evidence a highly positive clinical significance in all infants.

Conclusion:

The application of the modified restriction intervention protocol resulted in reliable and clinically significant changes in all cases.

Keywords:
Infants; Clinical efficacy; Upper extremit

Participants	Sex	Chronological age (months)	Diagnostic	Caregiver	Schooling	Age	Monthly family income (U$)
P1	M	18	CP spastic hemiparetic bilateral, GMFCS - IV; Mini-MACS - IV	Grandmother	Incomplete Middle School	41	519.16
P2	F	20	CP spastic hemiparetic, GMFCS - I; Mini-MACS - II	Grandmother	High School	38	1550.15
P3	F	20	CP spastic hemiparetic, GMFCS - I; Mini-MACS - I	Mother	Middle School	19	519.16
P4	F	6	CP spastic hemiparetic, GMFCS - III; Mini-MACS - III	Mother	University	24	1550.15
P5	M	15	Brachial Plexus Injury; Erb-Duchene	Grandmother	Elementary School	46	519.16

Participant	Evaluation	Pre-intervention	Post-intervention	Follow up	RCI (pre-, post-)
P1	PEDI Self-care	27.02	35.31	32.74	3.47
	PEDI Mobility	6.97	11.38	14.24	2.17
	PEDI Social function	34.24	37.01	40.60	2.50
	PMAL-R quantity	5.00	12.00	27.00	0.55
	PMAL-R quality	3.00	11.50	19.50	0.65
	AMIGO	2.00	10.00	7.00	2.82
P2	PEDI Self-care	49.34	55.05	55.76	2.39
	PEDI Mobility	45.26	56.26	58.20	5.42
	PEDI Social function	47.45	50.02	51.67	2.32
	PMAL-R quantity	0.00	39.50	38.00	3.11
	PMAL-R quality	0.00	48.50	23.00	3.73
	AMIGO	30.00	38.00	38.00	2.11
P3	PEDI Self-care	37.68	46.24	49.34	3.58
	PEDI Mobility	36.80	46.67	51.94	4.86
	PEDI Social function	47.45	48.32	50.02	0.78
	PMAL-R quantity	9.00	74.50	81.00	5.15
	PMAL-R quality	14.00	75.50	102.00	4.73
	AMIGO	26.00	32.00	34.00	2.11
P4	PEDI Self-care	35.31	39.85	52.94	1.90
	PEDI Mobility	6.97	14.24	27.85	3.58
	PEDI Social function	24.85	29.16	47.45	3.88
	PMAL-R quantity	12.00	48.00	45.00	2.83
	PMAL-R quality	20.50	49.50	48.00	2.23
	AMIGO	20.00	24.00	26.00	1.41
P5	PEDI Self-care	43.69	44.57	49.34	0.37
	PEDI Mobility	48.11	52.76	51.94	2.29
	PEDI Social function	46.56	47.45	49.18	0.80
	PMAL-R quantity	44.50	77.50	74.00	2.59
	PMAL-R quality	46.50	76.00	67.50	2.27
	AMIGO	17.00	31.00	34.00	4.93

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[1] * Correspondence: luziara@fmrp.usp.br