Cerebral Palsy (CP)
Conditions
Keywords
Constraint-Induced Movement Therapy, Functional Electrical Stimulation (FES), Upper Limb Rehabilitation, Spasticity
Brief summary
This randomized controlled trial aims to compare the effectiveness of Constraint-Induced Movement Therapy (CIMT) combined with Functional Electrical Stimulation (FES) versus CIMT alone in improving upper limb function, reducing spasticity, and enhancing functional independence in children with cerebral palsy (CP). A total of 46 children aged 3 to 15 years with spastic or dyskinetic cerebral palsy will be recruited from rehabilitation centers and hospitals in Sukkur, Pakistan. Participants will be randomly assigned into two groups: Group A will receive CIMT combined with FES, while Group B will receive CIMT alone. Both groups will undergo supervised therapy sessions five times per week for six weeks. Outcomes will be assessed before and after treatment using the Modified Ashworth Scale (MAS), Melbourne Assessment of Unilateral Upper Limb Function (MUUL), and Pediatric Evaluation of Disability Inventory (PEDI). The study aims to determine whether combining FES with CIMT provides greater improvements in motor recovery and daily functional performance in children with CP.
Detailed description
Cerebral palsy (CP) is one of the most common neurological disorders in children and is frequently associated with impaired upper limb function, spasticity, reduced motor control, and limitations in performing activities of daily living. Children with spastic and dyskinetic CP often experience difficulty in reaching, grasping, releasing, and manipulating objects, which negatively affects their independence and participation in daily activities. Various rehabilitation approaches have been developed to improve upper limb performance in children with CP, among which Constraint-Induced Movement Therapy (CIMT) has shown promising results in promoting cortical reorganization and functional use of the affected extremity. CIMT is based on restraining the less affected upper limb to encourage intensive use of the affected limb through repetitive and task-oriented activities. Although CIMT has demonstrated effectiveness in improving motor outcomes, some children still exhibit limited voluntary muscle activation and persistent spasticity that may reduce the overall effectiveness of therapy. Functional Electrical Stimulation (FES) has emerged as an adjunctive rehabilitation technique that may facilitate neuromuscular activation, improve motor learning, and enhance voluntary movement by delivering low-level electrical impulses to targeted muscles. The present study is designed to investigate the comparative effectiveness of CIMT combined with FES versus CIMT alone in children with cerebral palsy. The study will focus on evaluating changes in spasticity, upper limb function, and functional independence following a six-week intervention program. Participants will be randomly assigned into two treatment groups. Group A will receive CIMT combined with FES, while Group B will receive CIMT alone. Both groups will receive therapy sessions five times per week under the supervision of trained physiotherapists. Outcome measures will include the Modified Ashworth Scale (MAS) for assessment of spasticity, the Melbourne Assessment of Unilateral Upper Limb Function (MUUL) for evaluation of upper limb motor performance, and the Pediatric Evaluation of Disability Inventory (PEDI) for assessment of functional independence. Assessments will be conducted before and after the intervention period to determine treatment effectiveness. The findings of this study may contribute to evidence-based pediatric neurorehabilitation by identifying whether the addition of FES to CIMT provides superior therapeutic benefits compared to CIMT alone. The study may also help clinicians develop more effective rehabilitation protocols aimed at improving motor recovery, independence, and quality of life in children with cerebral palsy.
Interventions
PROCEDUREConstraint-Induced Movement Therapy Combined with Functional Electrical Stimulation
This intervention combines Constraint-Induced Movement Therapy (CIMT) with Functional Electrical Stimulation (FES) for rehabilitation of the affected upper limb in children with cerebral palsy. The unaffected upper limb will be restrained using a mitt or sling to encourage active use of the affected limb during repetitive, task-oriented activities such as reaching, grasping, stacking, drawing, and object manipulation. Functional Electrical Stimulation will be applied to selected upper limb muscles including wrist extensors and finger muscles using therapeutic electrical stimulation parameters (pulse width 200-300 microseconds, frequency 35-50 Hz, and on-off cycle of 10 seconds on and 20 seconds off). The intervention will be delivered for 60 minutes per session, five sessions per week, for six weeks under physiotherapist supervision.
PROCEDUREConstraint-Induced Movement Therapy
Constraint-Induced Movement Therapy (CIMT) will be provided to improve upper limb function in children with cerebral palsy by encouraging repetitive use of the affected extremity. The unaffected upper limb will be restrained using a mitt or sling while children perform structured, task-specific activities including grasping, reaching, releasing, drawing, feeding-related activities, stacking blocks, and play-based functional tasks. Therapy sessions will last 60 minutes each, five times per week for six weeks, with progression in task difficulty according to the child's functional abilities. No electrical stimulation will be applied in this intervention.
Sponsors
Montiha Azeem
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
3 Years to 15 Years
Healthy volunteers
No
Inclusion criteria
Children aged 3 to 15 years, including both male and female population. Diagnosed with cerebral palsy (CP), confirmed by medical assessment and clinical evaluation. Moderate to severe impairment in upper limb function (as determined by a relevant motor function assessment scale, e.g., the Modified Ashworth Scale. Children with spastic and dyskinetic types of cerebral palsy. Children with cognitive ability that allows for participation in therapy, as determined by minimental status examination. No history of recent interventions (e.g., surgery, Botox injections) that may interfere with study participation.
Exclusion criteria
Children with contraindications to functional electrical stimulation (e.g., pacemaker, skin conditions, or open wounds in the area of electrode placement). Presence of other significant neurological or musculoskeletal disorders that could confound the results (e.g., traumatic brain injury, muscular dystrophy)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Upper Limb Function Using Melbourne Assessment of Unilateral Upper Limb Function (MUUL) | 3 weeks and after 6 weeks of intervention | Upper limb function will be assessed using the Melbourne Assessment of Unilateral Upper Limb Function (MUUL), which evaluates the quality of unilateral upper extremity movement including reach, grasp, release, and object manipulation in children with cerebral palsy. Higher scores indicate better upper limb motor performance and functional ability. |
Countries
Pakistan
Contacts
PRINCIPAL_INVESTIGATORMuhammad Hafeezullah Tariq, MSPPT
The University of Lahore, Lahore
Outcome results
None listed