Constraint-induced movement therapy versus bimanual intensive therapy in children with hemiplegia showing low/very low bimanual functional performance: A randomized clinical trial.

INTRODUCTION: Children with infantile hemiplegia with low or very low bimanual functional performance have great impediments to spontaneously use their affected upper limb, which affects their performance of day-to-day activities and their quality of life. OBJECTIVE: To determine whether the order of application and the dose of modified constraint-induced movement therapy within a combined (hybrid) protocol influences the results of bimanual functional performance of the affected upper limb and the quality of life of children with congenital hemiplegia (5 to 8 years old) with low/very low bimanual functional performance. DESIGN: Single-blinded randomized controlled trial. PARTICIPANTS: Twenty-one children with congenital hemiplegia (5 to 8 years old) were recruited from two public hospitals and an infantile hemiplegia association in Spain. INTERVENTIONS: The experimental group (n = 11) received 100 hours of intensive therapies for the affected upper limb: 80 hours of modified constraint-induced movement therapy and 20 hours of bimanual intensive therapy. The control group (n = 10) received the same dose with 80 hours of bimanual intensive therapy and 20 hours of modified constraint-induced movement therapy. The protocol was provided 2 hours per day, 5 days per week, for 10 weeks. OUTCOME MEASURES: The primary outcome was bimanual functional performance, measured with the Assisting Hand Assessment, and the second outcome was quality of life, measured with the Pediatric Quality of Life Inventory Cerebral-Palsy module (PedsQL v. 3.0, CP module). Four assessments were performed: Weeks 0, 4, 8, and 10. RESULTS: The experimental group obtained an increase of 22 assisting hand assessment (AHA) units at week 8 with the application of modified constraint-induced movement, in contrast with the control group, which obtained an increase of 3.7 AHA units after bimanual intensive therapy. At week 10, the control group showed its greatest increase in bimanual functional performance, with 10.6 AHA units after modified constraint-induced movement therapy. Regarding quality of life, the greatest improvement occurred after modified constraint-induced movement, with 13.1 points in the experimental group (80 hours) and 6.3 points in the control group (20 hours). The protocol interaction was statistically significant for bimanual functional performance (p = .018) and quality of life (p = .09). CONCLUSIONS: Modified constraint-induced movement therapy is more beneficial than bimanual intensive therapy for improving upper limb functioning and quality of life in children with congenital hemiplegia showing low/very low bimanual performance. GOV IDENTIFIER: NCT03465046.

The efficacy of virtual reality tools for total knee replacement rehabilitation: A systematic review.

Purpose. To assess the effects of training with virtual reality tools (VRT) during rehabilitation of patients after total knee replacement (TKR). Methods. Systematic review. Six databases were queried. Search criteria included studies in which participants underwent TKR, took part in a rehabilitation protocol with VRT, and clinical outcomes of rehabilitation were considered. Available demographic, interventional and outcome data, along with functional, balance, and pain outcome measures were extracted. Patient satisfaction was also summarized. Results. Six trials were included. Available information shows that multi-modal intervention with VRT is used primarily to augment conventional rehabilitation. The Wii Balance Board is the most frequently used device. Conclusions. Findings suggest that an augmented VRT physical therapy intervention that is specifically-oriented to enhance balance could be more effective for overcoming balance limitations than standard physical therapy. However, rehabilitation with VRT has no advantage over conventional training for enhancing function, resolving pain, or increasing patient satisfaction after TKR. Future studies are needed to confirm the findings, particularly regarding the feasibility of preoperative and continued in-home intervention. Registration: CRD42017057087.