Constraint-Induced Movement Therapy for Children With Brain Tumors.

This was a non-randomized feasibility study with only nine children, so it cannot show that constraint-induced movement therapy caused the improvements or that it is better than standard therapy. Children with limited shoulder flexion or abduction of 30 degrees or less, or who could not initiate elbow, wrist, or digit movement, were excluded, so the findings may not apply to children with more severe movement limits. All participants were ambulatory, were not receiving active cancer therapy at the intervention, and had never previously participated in a constraint-induced movement therapy or other intensive therapy program, so the findings may not apply to children in active treatment or with prior intensive therapy. The program combined therapy sessions, cast restraint, shaping, repetitive task practice, a home program, and weekly phone support, so the contribution of any single component cannot be separated. The children had other neurological impairments, with visual deficits in 9 and seizure activity in 3, and one child had a lengthy hospitalization with activity restriction during follow-up. The authors could not identify patient or program factors that predicted improvement. The program was time- and resource-demanding, and 44% of parents felt participation was difficult. Quality-of-life findings were based on parent report, and one child had a clinically significant decline that the parent attributed to unrelated factors.

No conflicts of interest were declared.

Do not read the improved arm use as proof that constraint-induced movement therapy alone caused the change. The children received therapy sessions, cast restraint, shaping, repetitive task practice, a home program, and weekly phone support, and the contribution of any single component cannot be separated.