Brian Hoare1,2, Susan Greaves1,3. 1. Department of Paediatrics, Monash University, Clayton, Victoria, Australia. 2. CPtherapy, Australian Catholic University, Victoria, Australia. 3. Occupational Therapy Department, The Royal Children's Hospital, Victoria, Australia.
Abstract
BACKGROUND: There is high-level evidence supporting constraint-induced movement therapy (CIMT) and bimanual therapy for children with unilateral cerebral palsy. Evidence-based intervention includes time-limited, goal-directed, skills-based, intensive blocks of practice based on motor learning theory. AIM AND METHODS: Using supporting literature and clinical insight, we provide a theoretical rationale to highlight previously unreported differences between CIMT and bimanual therapy. DISCUSSION: The current emphasis on total dosage of practice for achieving positive outcomes fails to recognise the influence of other critical concepts within motor learning. Limitations exist in the application of motor learning principles using CIMT due to its unimanual nature. CIMT is effective for development of unimanual actions brought about by implicit learning, however it is difficult to target explicit learning that is required for learning how to use two hands together. Using bimanual therapy, object properties can be adapted to trigger goal-related perceptual and cognitive processes required for children to learn to recognise when two hands are required for task completion. CONCLUSION: CIMT and bimanual should be viewed as complementary. CIMT could be used to target unimanual actions. Once these actions are established, bimanual therapy could be used for children to learn how to use these actions for bimanual skill development.
BACKGROUND: There is high-level evidence supporting constraint-induced movement therapy (CIMT) and bimanual therapy for children with unilateral cerebral palsy. Evidence-based intervention includes time-limited, goal-directed, skills-based, intensive blocks of practice based on motor learning theory. AIM AND METHODS: Using supporting literature and clinical insight, we provide a theoretical rationale to highlight previously unreported differences between CIMT and bimanual therapy. DISCUSSION: The current emphasis on total dosage of practice for achieving positive outcomes fails to recognise the influence of other critical concepts within motor learning. Limitations exist in the application of motor learning principles using CIMT due to its unimanual nature. CIMT is effective for development of unimanual actions brought about by implicit learning, however it is difficult to target explicit learning that is required for learning how to use two hands together. Using bimanual therapy, object properties can be adapted to trigger goal-related perceptual and cognitive processes required for children to learn to recognise when two hands are required for task completion. CONCLUSION: CIMT and bimanual should be viewed as complementary. CIMT could be used to target unimanual actions. Once these actions are established, bimanual therapy could be used for children to learn how to use these actions for bimanual skill development.
Entities:
Keywords:
Cerebral palsy; bimanual therapy; constraint-induced movement therapy; motor learning theory
Authors: Brian J Hoare; Margaret A Wallen; Megan N Thorley; Michelle L Jackman; Leeanne M Carey; Christine Imms Journal: Cochrane Database Syst Rev Date: 2019-04-01
Authors: Anke Pm Verhaegh; Nienke B Nuijen; Pauline Bm Aarts; Maria W G Nijhuis-van der Sanden; Michèl Aap Willemsen; Brenda E Groen; Johanna E Vriezekolk Journal: BMC Pediatr Date: 2022-06-29 Impact factor: 2.567