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Constraint-Induced Movement Therapy for Children With Hemiplegia After Traumatic Brain Injury: A Quantitative Study

Cimolin, Veronica PhD; Beretta, Elena MD; Piccinini, Luigi MD; Turconi, Anna Carla MD; Locatelli, Federica MD; Galli, Manuela PhD; Strazzer, Sandra MD

Section Editor(s): Caplan, Bruce PhD, ABPP; Bogner, Jennifer PhD, ABPP

Journal of Head Trauma Rehabilitation: May/June 2012 - Volume 27 - Issue 3 - p 177–187
doi: 10.1097/HTR.0b013e3182172276
Focus on Clinical Research and Practice, Part 2

Objective: The aims of this study are to quantify the movement limitation of upper limbs in hemiplegic children with traumatic brain injury (TBI) by using a clinical-functional scale and upper limb kinematics and to evaluate the effectiveness of constraint-induced movement therapy (CIMT) on upper limbs.

Design: Pre-post study.

Setting: Clinical rehabilitation research laboratory.

Participants: Ten children with TBI.

Main Outcome Measures: The participants were evaluated by clinical examinations (Gross Motor Function Measure, Besta scale, Quality of Upper Extremities Skills Test, and Manual Ability Classification System) and 3D kinematic movement analysis of the upper limb before the CIMT program (pretest: 0.7 years after the injury) and at the end of the program (posttest: 10 weeks later).

Results: After the CIMT, most of the clinical measures improved significantly. Some significant improvements were present in terms of kinematics, in particular, in the movement duration and the velocity of movement execution of both tasks; the index of curvature and the average jerk improved, respectively, during reaching and hand-to-mouth task, while the adjusting sway parameter decreased during the 2 movements. Significant improvements were found in upper limb joint excursion after the rehabilitative programme too.

Conclusions: Our results suggest that the CIMT program can improve movement efficiency and upper limb function in children after TBI. The integration of the clinical outcomes and upper limb kinematics revealed to be crucial in detecting the effects of the CIMT programme.

Bioengineering Department, Politecnico di Milano, Milano, Italy (Drs Cimolin and Galli); IRCCS “E. Medea”–-La Nostra Famiglia, Bosisio Parini (LC), Italy (Drs Beretta, Piccinini, Turconi, Locatelli, and Strazzer); and IRCCS “San Raffaele Pisana”–-Tosinvest Sanità, Roma, Italy (Dr Galli).

Corresponding Author: Veronica Cimolin, PhD, Bioengineering Department, Politecnico di Milano, P.zza Leonardo da Vinci 32-20133 Milano, Italy (

The authors declare no conflicts of interest.

© 2012 Lippincott Williams & Wilkins, Inc.