Constraint-induced Movement Therapy Combined With Functional Electrical Stimulation in Children With Cerebral Palsy

Overview

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.

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.