Cerebral palsy in adult patients: constraint-induced movement therapy is effective to reverse the nonuse of the affected upper limb

Oliveira, Ana Cecília P.; Freitas, Camila de; Eras-Garcia, Rafael; Matuti, Gabriela S.; Santos, Juliana F.; Oliveira, Clarissa B.

doi:10.1590/0004-282X20150195

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Articles • Arq. Neuro-Psiquiatr. 74 (1) • Jan 2016 • https://doi.org/10.1590/0004-282X20150195 copy

Cerebral palsy in adult patients: constraint-induced movement therapy is effective to reverse the nonuse of the affected upper limb

A eficácia da terapia por contensão induzida em pacientes adultos com paralisia cerebral

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective

To determine if the original protocol of Constraint-Induced Movement Therapy (CIMT), is adequate to reverse the nonuse of the affected upper limb (AUL) in patients with Cerebral Palsy (CP) in adulthood.

Method

The study included 10 patients diagnosed with CP hemiparesis had attended the adult protocol CIMT, from January/August 2009/2014.

Results

Average age 24.6 (SD 9.44); MAL average pretreatment How Often (HO) = 0.72 and How Well (HW) = 0.68 and post-treatment HO = 3.77 and HW = 3.60 (p ≤ 0.001) and pretreatment WMFT average = 21.03 and post-treatment average = 18.91 (p = 0.350).

Conclusion

The constraint-induced movement therapy is effective to reverse the nonuse learn of the AUL in adult patients with CP.

cerebral palsy; adult; constraint-induced movement therapy

	Shoulder	Elbow	Wrist	Fingers	Thumb
Grade 2 (MAL < 2.5 for HO & HW scale)	Flexion ≥ 45º and Abduction ≥ 45º	Extension ≥ 20º from a 90º flexed starting position	Extension ≥ 20º	Extension of all MCP & IP (either PIP or DIP) joints ≥ 10º	Extension or abduction of thumb ≥ 10º
Grade 3 (MAL < 2.5 for HO & HW scale)	Flexion ≥ 45º and Abduction ≥ 45º	Extension ≥ 20º from a 90º flexed starting position	Extension ≥ 10º	Extension of MCP & IP (either PIP or DIP) joints of at least 2 fingers ≥ 10º	Extension or abduction of thumb ≥ 10º
Grade 4 (MAL < 2.5 for HO & HW scale)	Flexion ≥ 45º and Abduction ≥ 45º	Extension ≥ 20º from a 90º flexed starting position	Extension ≥ 10º	Extension of at least 2 fingers > 0º & < 10º	Extension or abduction of thumb ≥ 10º
Grade 5 (G4/5 MAL < 2.5 for HO & HW scale) Subclass A	Flexion ≥ 30º, Abduction ≥ 30º, or Scaption ≥ 30º	Initiation* of both flexion and extension	Must be able toeither initiate* extension of the wristor initiate* extension of any digit
Subclass B	Flexion ≥ 30º, Abduction ≥ 30º, or Scaption ≥ 30º	Extension ≥ 20º from a 90º flexed starting position	No active movement required at the wrist, fingers, or thumb

Age	Gender	GMFCS	Topographic diagnosis	Motor level
Average = 24.60 (SD = 9.44)	Female 60%	Level II 80%	Right Side 70%	Level 2 100%
Average = 24.60 (SD = 9.44)	Male 40%	Level III 20%	Left Side 30%

	N	Average	SD	p-value
MAL HO (Pre)	10	0.72	0.58
MAL HO (Post)		3.77	0.72	< 0,001
MAL HW (Pre)		0.68	0.49
MAL HW (Post)		3.60	0.71
WMFT (Pre)		21.03	15.09
WMFT (Post)		18.91	13.62	0,350

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[1] Correspondence
: Ana Cecília P. Oliveira; Avenida Prof. Ascendino Reis, 724; 04027-000 São Paulo SP, Brasil; E-mail:cicapo@hotmail.com