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Comparing Unimanual and Bimanual Training in Upper Extremity Function in Children With Unilateral Cerebral Palsy

Klepper, Susan E. PT, MS, PhD; Clayton Krasinski, Debra PT, MS, PhD; Gilb, Meaghan C. PT, DPT, PCS; Khalil, Nashwa PT, DPT, NCS

doi: 10.1097/PEP.0000000000000438
Systematic Review

Purpose: This systematic review compared intensive bimanual therapy (IBT) and modified constraint-induced movement therapy (mCIMT) in upper limb function in children with unilateral cerebral palsy (CP).

Methods: Four electronic databases were searched from 2009 through October 2015 for randomized control trials comparing IBT with mCIMT.

Results: Eight articles met the inclusion criteria; 5 randomized clinical trials with 221 participants with unilateral CP, ages 1.5 to 16 years, who received the intervention in a day camp, clinical, or preschool setting were included. The IBT group performed bimanual motor activities; the mCIMT group performed unilateral motor activities.

Conclusion: There was a strong, nonspecific recommendation for either approach to improve quality of unimanual movement, bimanual capacity, and movement efficiency. There was a weak, specific recommendation for IBT in improving movement quality and a specific but weak recommendation favoring IBT to improve the child's performance on parent-reported outcomes.

This systematic review compared intensive bimanual therapy and modified constraint-induced movement therapy in upper limb function in children with unilateral cerebral palsy.

Program in Physical Therapy and Department of Rehabilitation and Regenerative Medicine (Drs Klepper and Krasinski), Columbia University, New York; Rusk Institute (Dr. Khalil), New York University Medical Center, New York; and Children's Health (Dr. Gilb), Children's Medical Center of Dallas, Dallas, Texas.

Correspondence: Debra Clayton Krasinski, PT, MS, PhD, 710 West 168th St, 8th Floor, New York, NY 10032 (dck6@cumc.columbia.edu).

At the time of this research, Drs Khalil and Gilb were students in the Clinical Doctor of Physical Therapy Program, Columbia University; Dr Klepper was Assistant Professor of the Program in Physical Therapy and Rehabilitation and Regenerative Medicine, Columbia University—now retired; Dr Krasinski was Assistant Dean, Associate Professor, and Director of the Program in Physical Therapy and Vice Chair Department of Rehabilitation and Regenerative Medicine, Columbia University.

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The authors declare no conflicts of interest.

Copyright © 2017 Wolters Kluwer Health, Inc. and Section on Pediatrics of the American Physical Therapy Association. All rights reserved.