{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T21:01:57Z","timestamp":1765486917404,"version":"3.40.5"},"reference-count":46,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2023,6,19]],"date-time":"2023-06-19T00:00:00Z","timestamp":1687132800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["PM&amp;R"],"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Children with infantile hemiplegia with low or very low bimanual functional performance have great impediments to spontaneously use their affected upper limb, which affects their performance of day\u2010to\u2010day activities and their quality of life.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To determine whether the order of application and the dose of modified constraint\u2010induced movement therapy within a combined (hybrid) protocol influences the results of bimanual functional performance of the affected upper limb and the quality of life of children with congenital hemiplegia (5 to 8\u2009years old) with low\/very low bimanual functional performance.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Single\u2010blinded randomized controlled trial.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>Twenty\u2010one children with congenital hemiplegia (5 to 8\u2009years old) were recruited from two public hospitals and an infantile hemiplegia association in Spain.<\/jats:p><\/jats:sec><jats:sec><jats:title>Interventions<\/jats:title><jats:p>The experimental group (n\u2009=\u200911) received 100\u2009hours of intensive therapies for the affected upper limb: 80\u2009hours of modified constraint\u2010induced movement therapy and 20\u2009hours of bimanual intensive therapy. The control group (n\u2009=\u200910) received the same dose with 80\u2009hours of bimanual intensive therapy and 20\u2009hours of modified constraint\u2010induced movement therapy. The protocol was provided 2\u2009hours per day, 5\u2009days per week, for 10\u2009weeks.<\/jats:p><\/jats:sec><jats:sec><jats:title>Outcome Measures<\/jats:title><jats:p>The primary outcome was bimanual functional performance, measured with the Assisting Hand Assessment, and the second outcome was quality of life, measured with the Pediatric Quality of Life Inventory Cerebral\u2010Palsy module (PedsQL v. 3.0, CP module). Four assessments were performed: Weeks 0, 4, 8, and 10.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The experimental group obtained an increase of 22 assisting hand assessment (AHA) units at week 8 with the application of modified constraint\u2010induced movement, in contrast with the control group, which obtained an increase of 3.7 AHA units after bimanual intensive therapy. At week 10, the control group showed its greatest increase in bimanual functional performance, with 10.6 AHA units after modified constraint\u2010induced movement therapy. Regarding quality of life, the greatest improvement occurred after modified constraint\u2010induced movement, with 13.1 points in the experimental group (80\u2009hours) and 6.3 points in the control group (20\u2009hours). The protocol interaction was statistically significant for bimanual functional performance (<jats:italic>p<\/jats:italic>\u2009=\u2009.018) and quality of life (<jats:italic>p<\/jats:italic>\u2009=\u2009.09).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Modified constraint\u2010induced movement therapy is more beneficial than bimanual intensive therapy for improving upper limb functioning and quality of life in children with congenital hemiplegia showing low\/very low bimanual performance.<\/jats:p><\/jats:sec><jats:sec><jats:title>ClinicalTrials.gov Identifier<\/jats:title><jats:p>NCT03465046.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pmrj.12990","type":"journal-article","created":{"date-parts":[[2023,5,4]],"date-time":"2023-05-04T08:28:43Z","timestamp":1683188923000},"page":"1536-1546","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Constraint\u2010induced movement therapy versus bimanual intensive therapy in children with hemiplegia showing low\/very low bimanual functional performance: A randomized clinical trial"],"prefix":"10.1002","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4034-2585","authenticated-orcid":false,"given":"Roc\u00edo","family":"Palomo\u2010Carri\u00f3n","sequence":"first","affiliation":[{"name":"University of Castilla\u2010La Mancha  Toledo Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Asunci\u00f3n","family":"Ferri\u2010Morales","sequence":"additional","affiliation":[{"name":"University of Castilla\u2010La Mancha  Toledo Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sara","family":"Ando\u2010LaFuente","sequence":"additional","affiliation":[{"name":"University of Castilla\u2010La Mancha  Toledo Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rub\u00e9n Arroyo","family":"Fern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Universidad de Castilla\u2010La Mancha Facultad de Fisioterapia y Enfermer\u00eda  Toledo Castilla\u2010La Mancha Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jose Ignacio Calvo","family":"Arenillas","sequence":"additional","affiliation":[{"name":"Universidad De Salamanca Enfermeria Y Fisioterapia  Salamanca Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Virgilia","family":"Ant\u00f3n\u2010Ant\u00f3n","sequence":"additional","affiliation":[{"name":"University of Castilla\u2010La Mancha  Toledo Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elisabeth Bravo","family":"Esteban","sequence":"additional","affiliation":[{"name":"Universidad de Castilla\u2010La Mancha Facultad de Fisioterapia y Enfermer\u00eda  Toledo Castilla\u2010La Mancha Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,6,19]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1017\/S001216220500112X"},{"volume-title":"Cerebral Palsies: Epidemiology and Causal Pathways","year":"2000","author":"Stanley F","key":"e_1_2_8_3_1"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1080\/01942638.2017.1280873"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1177\/08830738060210110401"},{"issue":"4","key":"e_1_2_8_6_1","article-title":"Constraint\u2010induced movement therapy in children with unilateral cerebral palsy","volume":"4","author":"Hoare BJ","year":"2019","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1044\/1092-4388(2008\/018)"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1177\/1545968304272701"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2008-3335"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/dmcn.12273"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2377-13-68"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/oti.321"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1177\/1545968311402508"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-8749.2007.00830.x"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-8749.2010.03859.x"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.3109\/01942638.2014.925027"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2010.12.003"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.spen.2004.01.009"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.3109\/17518423.2014.948641"},{"issue":"11","key":"e_1_2_8_20_1","first-page":"248","article-title":"Modified constraint\u2010induced movement therapy at home\u2010is it possible? 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