Modified Constraint Induced Movement Therapy Versus Virtual Reality Training in Children With Cerebral Palsy

Riphah International University20 enrolled

Overview

Children with hemiplegic cerebral palsy (CP) are characterized by motor impairments mainly lateralized to one side of the body, with greater upper limb than lower limb involvement; these impairments may further limit the daily activities and school participation of children with hemiplegic CP. For the improvement of activity limitations in hemipelagic cerebral palsy children will take 20 hemiplegic cerebral palsy children with the age of 5-16 year all participants will be randomly assign and use modified Constraint induced movement therapy and virtual reality techniques. mCIMT and Hot pack will be given to group I and unaffected hand will immobilized by a volar resting splint extending from finger tips to the proximal forearm. Use splint every day for at least 5 waking hours individualized, 18-hour program of mCIMT every other day, 3 times per week during a 4-week period. Each modified CIMT session continued for 1.5 hours will give to group I on the other hand VR and Hot pack will give to group II and 18-hour VR program, every other day, 3 times per week for 4 weeks will give Each VR session continued for 1.5 hours. Then evaluate both groups on follow up. All the data will be collected from Rising Sun Institute by using ABILHAND-KIDS questionnaire and Children's hand-use experience questionnaire. The reliability and validity of tools and mentioned. The duration of study will be 6-months. Data will be analyzed with the help of SPSS 27

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

OTHER

Masking

SINGLE

Enrollment

Conditions

Hemiplegic Cerebral Palsy

Interventions

mCIMTOTHER

mCIMT+ Hot pack will be applied and unaffected hand will be immobilized by a volar resting splint extending from finger tips to the proximal forearm. Use splint every day for at least 5 waking hours daily for 4 weeks and perform daily activities. Program of mCIMT every other day, 3 times per week during a 4-week period.

VROTHER

VR+ Hot pack will be applied. 25 minutes of VR program, every other day, 3 times per week for 4 weeks. Each VR session continued for 10 minutes then 5 minutes rest after that again 10 minutes VR session will do.

Eligibility

Sex: ALLMin age: 6 YearsMax age: 12 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Age range between 5 to 16 years of age. * Medical diagnosis of spastic hemiparetic CP. * At least 20◦wrist and 10◦ active finger extension from full flexion. * More movement deficits in 1 upper extremity (less than 2.5 on the Amount of Use scale (AOU) on the Pediatric Motor Activity Log (PMAL)). * Muscle tone less than 3 on the Modified Ashworth Scale. * Normal or corrected-to-normal vision and hearing. * Classified level I, II, or III of the Manual Ability Classification System ( MACS) for Children with CP Exclusion Criteria: * Health problems not associated with CP. * Seizure hemispatial neglect. * Orthopaedic surgery on the involved upper extremity. * Botulinum toxin therapy for the affected upper extremity within the past 6 months or within the study period. * Balance problems

Outcomes

Primary Outcomes

CHEQ (Children's hand-use experience questionnaire)

CHEQ has been developed to capture children's perceived quality of performance when using the affected hand in these situations. CHEQ is an internet-based questionnaire containing 29 items (bimanual activities) presented one by one in random order. Test-retest reliability for the three CHEQ scale was: grasp efficacy, ICC=0.91; time taken, ICC=0.88; and feeling bothered, ICC=0.91. Total Maximum score of each component (quality, duration \& psycho-status) was 100 and total maximum score of hand use was 27. Higher the results showed improvement in hand function

Time frame: Baseline, 4th week and 8th week

ABILHAND-KIDS questionnaire

ABILHAND-KIDS questionnaire is a valuable tool to assess a child's unimanual and bimanual upper limb activities. The reliability of the ABILHANDS-Kids is good across different observers as a performance- and capacity-based rating method. Test-retest reliability was 0.92. Total Maximum score was 42, mid score was 21 and minimum score was 0. Higher scores showed improvement in activity level of hand use