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• W2012341064 abstract "SIR–We read with interest Sakzewski et al.’s recent publication of the findings of the INCITE study comparing constraint-induced movement therapy (CIMT) and bimanual training in children with congenital hemiplegia.1 It was encouraging to note increased use of the paretic hand in performance of bimanual tasks at 3 weeks in both groups as measured by the Assisting Hand Assessment. However, we were also keen to establish whether constraint of the less affected limb led to any deleterious effects on its function. The authors state in the method section that ‘Grip strength and Jebsen Taylor Test of Hand Function (JTTHF)2 were measured on both the impaired and unimpaired hand to determine whether there were deleterious effects of wearing a constraint on the unimpaired limb’. In the results section it is stated that there were no deleterious effects on the unimpaired upper limb for the CIMT group at any follow-up; Table SI is referred to in support of this statement. Detailed inspection of Table SI is rather disappointing. In contrast to Table III in the main text, no estimates of the mean difference over time within-group are provided, making it difficult to find evidence to support their statement. Additionally, different measures of spread are used for the JTTHF and grip strength in this table (95% confidence intervals) compared with Table I in the main text which provides the baseline median values and interquartile range. This further complicates any comparison. However, our attention was drawn to the apparent deterioration in performance on the JTTHF at 3 weeks (as well as a more minor dip in median grip strength) in the group randomized to constraint therapy (see Table I in this letter). The JTTHF is a test of the time taken (in s) to perform a series of tasks. Thus, the median time to complete the JTTHF with the less affected hand was 7.5 seconds longer at 3 weeks in the CIMT group than at baseline. This difference is not mentioned in the discussion. It would be valuable to have more information about the reason for the difference in median times, which on the face of it would seem to be clinically significant in the short-term. There is mounting evidence that the function of both upper limbs is adversely affected in hemiplegia, even in the presence of a clearly unilateral brain lesion. Whilst the most extensive investigation of this effect has been following adult stroke,3 it is even more important to consider the less affected limb in childhood hemiplegia,4 as motor control is immature during childhood5 and should be given every chance to develop to its full extent. Thus, when considering whether to constrain or not to constrain in childhood hemiplegia, the effect on the less affected limb must also be carefully evaluated." @default.
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• W2012341064 date "2012-02-21" @default.
• W2012341064 modified "2023-09-23" @default.
• W2012341064 title "A plea for consideration of the less affected hand in therapeutic approaches to hemiplegia" @default.
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• W2012341064 doi "https://doi.org/10.1111/j.1469-8749.2012.04242.x" @default.
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