Constraint-induced movement therapy of upper limb of children with cerebral palsy in clinical practice: systematic review of the literature

ABSTRACT The purpose of the present study was to perform a systematic review of the literature to investigate how and with what modifications or adaptations constraint-induced movement therapy has been employed in clinical practice for therapeutic interventions in children with cerebral palsy. Searches were conducted of the CAPES (Brazilian fostering agency) periodical portal, Pubmed, Bireme, Science Direct, Scielo and PEDro databases for relevant articles published between January 2010 and May 2016. The articles retrieved were evaluated, scored and qualified by two blinded reviewers using the Physical therapy Evidence Database Scale. The searches led to the retrieval of 102 articles, 12 of which were included in the present systematic review. A table was created containing information on the study groups, inclusion criteria, intervention, intervention frequency, difficulties encountered, evaluations and outcomes. Considerable variety was found in the therapeutic intervention models. The findings of the present review demonstrate that constraint-induced movement therapy in pediatric clinical practice is not employed in its original form. Although the studies analyzed did not have a common methodology regarding the use of this type of therapy, the method has been adapted with considerable flexibility, providing promising, positive results regarding the therapeutic intervention of the paretic upper limb in children with cerebral palsy.

摘要 本研究旨在通过系统文献综述，探究强制性诱导运动疗法（Constraint-Induced Movement Therapy）在脑瘫（Cerebral Palsy）患儿临床治疗干预中的应用方式，以及其经过了哪些修改或适配调整。研究检索了CAPES（巴西资助机构）期刊门户、PubMed、Bireme、Science Direct、SciELO及PEDro数据库中2010年1月至2016年5月期间发表的相关文献。由2名盲法评价者采用物理治疗证据数据库量表（Physical Therapy Evidence Database Scale）对检索获取的文献进行评估、评分与质量分级。本次检索共获得102篇文献，其中12篇被纳入本系统综述。研究者构建了信息表格，涵盖研究分组、纳入标准、干预方案、干预频次、所遇困难、评价指标与研究结局。现有治疗干预模型存在显著多样性。本综述结果显示，儿科临床实践中所采用的强制性诱导运动疗法并未沿用其原始范式。尽管纳入分析的各项研究在该疗法的应用方法上未形成统一标准，但该疗法已被灵活调整适配，在脑瘫患儿偏瘫上肢的治疗干预中展现出可观的积极效果。