The effect of combining daily restraint with bimanual intensive therapy in children with hemiparetic cerebral palsy: A self-control study

Aim: To examine the influence of combining restraint therapy with bimanual intensive therapy on the unimanual and bimanual function among children with hemiparetic cerebral palsy (CP). Included were nine children (ages 6-9 yr), with Manual Ability Classification System scores of 2-3, Gross Motor Functional Classification System 1-2; Intervention: 10 days, six hours per day including one hour of restraint followed by five hours of bimanual activities. Evaluations: One month and immediately prior to the intervention (as the control period), immediately, two months and six months post-intervention. The Assisting Hand Assessment was the primary outcome measure, along with the Jebsen-Taylor Test of Hand Function, the Jamar pinch gauge for grip and pinch, and the Pediatric Evaluation of Disability Inventory (PEDI). Results: No significant change was observed during the pre-intervention control period in any of the outcome measures; a significant improvement in all outcome parameters was noted after the intervention as compared to the control period. These achievements were still significantly higher than baseline values at six months post-intervention. Conclusion: Children with hemiparetic CP at this level of impairment might benefit from a short daily intervention program of combining restraint with bimanual training in order to improve unimanual and bimanual function.