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Randomized comparison trial of rehabilitation very early for infants with congenital hemiplegia
Boyd, Roslyn N. Greaves, Susan Ziviani, Jenny Novak, Iona Badawi, Nadia Pannek, Kerstin Elliott, Catherine Wallen, Margaret Morgan, Catherine Valentine, Jane
Boyd, Roslyn N.
Greaves, Susan
Ziviani, Jenny
Novak, Iona
Badawi, Nadia
Pannek, Kerstin
Elliott, Catherine
Wallen, Margaret
Morgan, Catherine
Valentine, Jane
Author
Boyd, Roslyn N.
Greaves, Susan
Ziviani, Jenny
Novak, Iona
Badawi, Nadia
Pannek, Kerstin
Elliott, Catherine
Wallen, Margaret
Morgan, Catherine
Valentine, Jane
Findlay, Lisa
Guzzetta, Andrea
Whittingham, Koa
Ware, Robert S.
Fiori, Simona
Maitre, Nathalie L.
Heathcock, Jill
Scott, Kimberley
Eliasson, Ann-Christin
Sakzewski, Leanne
Greaves, Susan
Ziviani, Jenny
Novak, Iona
Badawi, Nadia
Pannek, Kerstin
Elliott, Catherine
Wallen, Margaret
Morgan, Catherine
Valentine, Jane
Findlay, Lisa
Guzzetta, Andrea
Whittingham, Koa
Ware, Robert S.
Fiori, Simona
Maitre, Nathalie L.
Heathcock, Jill
Scott, Kimberley
Eliasson, Ann-Christin
Sakzewski, Leanne
Abstract
Objective
To compare efficacy of constraint-induced movement therapy (Baby-CIMT) with bimanual therapy (Baby-BIM) in infants at high risk of unilateral cerebral palsy.
Study design
This was a single-blind, randomized-comparison-trial that had the following inclusion criteria: (1) asymmetric brain lesion (2) absent fidgety General Movements, (3) Hammersmith Infant Neurological Examination below cerebral palsy cut-points, (4) entry at 3-9 months of corrected age, and (5) >3-point difference between hands on Hand Assessment Infants (HAI). Infants were randomized to Baby-CIMT or Baby-BIM, which comprised 6-9 months of home-based intervention. Daily dose varied from 20 to 40 minutes according to age (total 70-89.2 hours). Primary outcome measure was the HAI after intervention, with secondary outcomes Mini-Assisting Hand Assessment and Bayley III cognition at 24 months of corrected age.
Results
In total, 96 infants (51 male, 52 right hemiplegia) born median at 37-weeks of gestation were randomized to Baby-CIMT (n = 46) or Baby-BIM (n = 50) and commenced intervention at a mean 6.5 (SD 1.6) months corrected age. There were no between group differences immediately after intervention on HAI (mean difference [MD] 0.98 HAI units, 95% CI 0.94-2.91; P = .31). Both groups demonstrated significant clinically important improvements from baseline to after intervention (Baby-BIM MD 3.48, 95% CI 2.09-4.87; Baby-CIMT MD 4.42, 95% CI 3.07-5.77). At 24 months, 64 infants were diagnosed with unilateral cerebral palsy (35 Baby-CIMT, 29 Baby-BIM). Infants who entered the study between 3 and 6 months of corrected age had greater change in HAI Both Hands Sum Score compared with those who entered at ≥6 months of corrected age (MD 7.17, 95% CI 2.93-11.41, P = .001).
Conclusions
Baby-CIMT was not superior to Baby-BIM, and both interventions improved hand development. Infants commencing intervention at <6 months corrected age had greater improvements in hand function.
Keywords
Date
2025
Type
Journal article
Journal
Journal of Pediatrics
Book
Volume
277
Issue
Page Range
1-13
Article Number
Article 114381
ACU Department
School of Allied Health
Faculty of Health Sciences
Faculty of Health Sciences
Collections
Relation URI
Source URL
Event URL
Open Access Status
Published as ‘gold’ (paid) open access
License
CC BY 4.0
File Access
Open
Notes
© 2024 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).