Twelve children (age 1 to 8 years) with chronic (>1 year) hemiparesis were treated by forced use, or constraint-induced, movement therapy at Tulane University School of Medicine, New Orleans, LA. Each received a plaster cast on the unaffected arm for 1 month, while 13 hemiparetic control children did not. Peabody Developmental Motor Scales (PDMS) and parental reports, used to assess change in function, were obtained on all children at entry, and at 1 month, 6 months, and 7 months after entry. Controls received casts after 6 months.

The casted children improved 12.6 PDMS points after 1 month, while the controls showed only 2.5 points improvement. Improvements had persisted in 7 children who returned after 6 months for follow-up testing. Ten control children who received casts at crossover showed similar gains in function. The measured improvements were corroborated by parental reports. Ongoing physical/occupational therapy was received by both casted and control patients and did not explain the greater improvement observed in the casted group. [1]

COMMENT. Constraint-induced movement therapy has been proven effective in the rehabilitation of adults with stroke and hemiparesis. The above study at Tulane has demonstrated the benefits of this technique in children with hemiparetic cerebral palsy. Cerebrocortical reorganization is postulated as the mechanism of this form of therapy.