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Table 2 offers a summary of the studies and relevant characteristics. The inclusion criteria are listed to allow a comparison of patient characteristics and the results. Type and frequency of the intervention employed are essential for understanding how CIMT is performed in clinical practice.

Table 3 lists the main outcomes of the clinical trials analyzed in the present systematic review. One hundred two articles were retrieved from the initial searches of the databases. Following the analyses of the titles, abstracts and full texts as well as the scoring of methodological quality using the PEDro scale score of 6 or more points , 12 articles met the eligibility criteria and were selected for the present systematic review. Figure 1 displays the flowchart of the article selection process.

The patient engages in six hours of intensive training of the affected upper limb for 10 of the 14 days using a set of activities involving repetitive actions and formation therapy. Morris et al. A substantial number of studies published in recent years demonstrate that CIMT leads to considerable neuroplastic cortical reorganization and to improved function of the upper limb in both the short and long terms. In a pioneering study, Liepert et al. In all studies analyzed in the present systematic review, games and functional activities were used during CIMT, but methodological quality, sample size, treatment modality, training intensity and evaluation tools differed among the studies.

CIMT was not employed in its classic form and was modified with respect to the constraint method, duration of constraint days or weeks , type and duration of therapy, intervention setting home, school or clinic and intervention provider therapist, parent or teacher. The first significant variant was the method employed to constrain the unaffected limb, for which a range of techniques was used, such as a mitt 21 22 24 25 26 28 , sling 17 18 19 20 , cast 27 and splint Secondly, the treatment programs varied the intensity, ranging from 4 weeks of intervention distributed in 10 days, 2 hours a day, totaling 20 hours of intervention 23 for 4 weeks, distributed in 21 days, 6 hours per session, totaling hours of intervention The fact that the frequency, intensity and duration varied among the trials analyzed in the present review limits the development of guidelines regarding these aspects in interventions involving CIMT for children with CP.

In two clinical trials conducted by Aarts et al. Choudhary et al. The clinical trials of Sakzewski L et al. The use of containment at home after treatment sessions was not used in any clinical trial.

Evidence-based Therapies

Chen et al. For the functional classification of individuals eligible for inclusion in the study, the Manual Abilities Classification System MACS was used in two studies 17 18 , which was developed to categorize, respectively, the mobility and manual function of children with CP 31 It is recognized that the PMAL evaluation scale is an evaluation tool of little reliability and insufficient validity The classification of muscle tone at the time of treatment was determined in some studies, using grades 1 and 2 of the modified Ashworth Scale as part of the inclusion criteria.

Cognitive capacity, cooperation and comprehension of the commands were employed as inclusion criteria in the majority of studies, which are essential to conducting studies of this nature and obtaining the expected benefits. According to Moura 34 , adequate treatment planning is fundamental and requires ample knowledge of all upper limb disorders. A clinical evaluation combined with quantitative upper limb measures can provide necessary information for the detection of clinically significant changes in upper limb function, following an intervention.

All studies selected presented valid and reliable results using one or more types of primary and secondary evaluations. In two clinical trials, Aarts et al. Other outcome measures were employed in the remaining studies.

Hsin et al. Along with other measures, Sakzewski et al. Along with previously described measures, Wallen et al. All studies included in the present systematic review reported significant improvements in some outcome measure, demonstrating the positive effects of the proposed treatment during both the post-intervention and follow-up evaluations. Despite the small sample sizes, all studies offered satisfactory consistency regarding the outcome measures.

The majority of studies reported difficulties with the use of CIMT for children with CP, but the reason for the found difficulties does not have the correlation of something with a restraint of a non-affected limb or there is a process of irritability during a therapy.

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Evidence-Based Child Therapy

In 9 of the 12 clinical trials 17 18 19 20 22 23 25 26 27 , difficulties and dropouts occurred due to family problems, scheduling problems, changes of address and a lack of transportation. In the study by Sakzewski et al. In the study by Chen et al. Information regarding the types of intervention, modifications and dose-response relationship as well as the effects on structural and functional changes in children with CP is fundamental to the development of guidelines for the reliable, reproducible practice of CIMT.

Recent Articles

The present systematic review of the literature findings demonstrate that, despite the lack of a common methodology among studies regarding the use of constraint-induced movement therapy for children with cerebral palsy, this form of intervention has been adapted with considerable flexibility, providing promising, positive results of the therapeutic intervention of the paretic upper limb.

Because of this limitation in our study, a summary of outcome measures is required, as well as synthesis of data on the studies reviewed in a future version. The authors declare no conflicts of interest in relation to this study. The authors alone are responsible for the content and writing of the paper.

No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated. Methods of constraint-induced movement therapy for children with hemiplegic cerebral palsy: development of a child-friendly intervention for improving upper-extremity function. Arch Phys Med Rehabil.

Rapport-Building and Check-In Activities for Child Therapy Sessions

Intensive upper extremity training for children with hemiplegia: from science to practice. Semin Pediatr Neurol. Efficacy of upper limb therapies for unilateral cerebral palsy: a meta-analysis. Fisioter Mov. Med Reabil. Treament-induced cortical reorganization after stroke in humans. Neurorehabil Neural Repair.

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Technique to improve chronic motor deficit after stroke. Constraint-induced movement therapy: a new family of techniques with broad application to physical rehabilitation: a clinical review. J Rehabil Res Dev. Guidelines for future research in constraint-induced movement therapy for children with unilateral cerebral palsy: an expert consensus. Dev Med Child Neurol. The behavior-analytic origins of constraint-induced movement therapy: an example of behavioral neurorehabilitation.

Behav Anal. Intensive pediatric constraint-induced therapy for children with cerebral palsy: randomized, controlled, crossover trial. J Child Neurol. Studies comparing the efficacy of constraint-induced movement therapy and bimanual training in children with unilateral cerebral palsy: a systematic review.

Dev Neurorehabil. Effectiveness of constraint-induced movement therapy on upper-extremity function in children with cerebral palsy: a systematic review and meta-analysis of randomized controlled trials. Clin Rehabil. PEDro: the physiopherapy evidence database. Effectiveness of modified constraint-induced movement therapy in children with unilateral spastic cerebral palsy: a randomized controlled trial. Modified constraint-induced movement therapy combined with bimanual training mCIMT-BiT in children with unilateral spastic cerebral palsy: how are improvements in arm-hand use established?

Res Dev Disabil. Functional impact of constraint therapy and bimanual training in children with cerebral palsy: a randomized controlled trial. Am J Occup Ther. Adapted version of constraint-induced movement therapy promotes functioning in children with cerebral palsy: a randomized controlled trial.


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Improvement of upper extremity motor control and function after home-based constraint induced therapy in children with unilateral cerebral palsy: immediate and long-term effects. Effect of therapist-based constraint-induced therapy at home on motor control, motor performance and daily function in children with cerebral palsy: a randomized controlled study.

Efficacy of modified constraint induce movement therapy in improving upper limb function in children with hemiplegic cerebral palsy: a randomized controlled trial. Brain Dev. Efficacy of constraint-induced therapy on functional performance and health-related quality of life for children with cerebral palsy: a randomized controlled trial.

Best responders after intensive upper-limb training for children with unilateral cerebral palsy. Randomized comparison trial of density and context of upper limb intensive group versus individualized occupational therapy for children with unilateral cerebral palsy. Multicenter randomized controlled trial of pediatric constraint-induced movement therapy: 6-month follow-up. Modified constraint-induced therapy for children with hemiplegic cerebral palsy: a randomized trial. Constraint-induced movement therapy: characterizing the intervention protocol.

Eura Medicophys.

Treatment-induced cortical reorganization after stroke in humans. Effects of constraint-induced movement therapy in young children with hemiplegic cerebral palsy: an adapted model.

Additional information

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