Effectiveness of Enhanced Constraint-Induced Movement Therapy on Upper Limb Function in Cerebral Palsy: A Randomized Controlled Trial in Pakistan
Abstract
Background: Children with hemiplegic cerebral palsy are often capable of attending school; however, due to impaired upper limb function, their involvement in educational and recreational activities is frequently limited. This leads to reduced participation in social and daily functional tasks. Constraint-Induced Movement Therapy (CIMT) is a targeted intervention designed to improve upper limb function in such children. Objective: To determine whether an improved form of Constraint-Induced Movement Therapy (e-CIMT) can help children with cerebral palsy at the District Headquarter Hospital in Khanewal, Pakistan, improve their hand function. Methods: A single-blind randomized controlled trial (RCT) was conducted in the Department of Physical Therapy, District Headquarter (DHQ) Hospital, Khanewal, Pakistan, from April 2024 to April 2025. Using a non-probability convenient sampling technique, 96 children (aged 5 to 12 years) diagnosed with hemiplegic cerebral palsy were enrolled and randomly divided into two-groups (48 participants per group). The experimental group received expanded CIMT combined with routine physiotherapy, while the control group underwent only routine physiotherapy. Outcomes were assessed using the Paediatric Motor Activity Log (PMAL) and the Wolf Motor Function Test (WMFT). Ethical approval was obtained from the DHQ Khanewal research board, and the study was registered prospectively with the ClinicalTrials.gov registry (Trial ID: 57520). Results: Comparing the experimental group to the control group revealed notable improvements. The PMAL scores improved considerably (p ≤ 0.001), and both domains of the WMFT showed statistically significant enhancements in the experimental group (p < 0.001). Improvements within the experimental group were also highly significant for hand function metrics. Conclusion: When combined with regular physical treatment, expanded constraint-induced movement therapy significantly improves upper limb functionality in children with hemiplegic cerebral palsy more than ordinary physiotherapy does on its own.
