Article Critique

Randomized controlled trial combining constraint-induced

movement therapy and action-observation training in
unilateral cerebral palsy: clinical effects and influencing
factors of treatment response
(Simon-Martinez et. al., 2020)

This is a critique for [Simon-Martinez C., Mailleux L., & Hoskens J. (2020).
Randomized controlled trial combining constraint-induced movement
therapy and action-observation training in unilateral cerebral palsy: clinical
effects and influencing factors of treatment response. Therapeutic Advances
in Neurological Disorders, 13, 1–13.]

Abstract:
The abstract was structured, states the purpose of the study, contains a brief
background about the methods and results of the study and it is not long. It
was proved that active observation therapy (AOT) in combination with
Constrained induced movement therapy (CIMT) resulted in a better outcome
for children with poor motor function and high amounts of mirror
movements.

Title:
The title indicates what the research is about, but it is too long and can be
equally informative with fewer words.

The variable is stated clearly as it measures the effect of (CIMT) and (AOT)
combination therapy in unilateral cerebral palsy(uCP).

Introduction:
The purpose of the study is to show the effect of CIMT in combination with
AOT on UL in unilateral affection of CP and the poor bimanual hand
function as a problem was stated clearly.
The significance of the study was proved using many articles from the
literature and the research question was clear.

The researchers have provided a clear research question and the null
hypothesis was stated using the lack of previous strong evidence that
supports it.

Methods:
Both inclusion and exclusion criteria were stated clearly, as the researchers
recruited 44 children with uCP from both genders between June 2014 and
June 2017 via the cerebral palsy (CP) reference center of the University
Hospitals Leuven

Inclusion criteria were:

(A) Confirmed diagnosis of uCP.

(B) Age between 6–12years.

(c) Sufficient cooperation to complete the activities and assessments.

(d) Minimal ability to actively grasp and stabilize an object with the more
impaired hand (House Functional Classification Score [HFC]⩾4).

Researchers have used an exclusion criterion that was:

(A) UL surgery in the last 2 years

(B) Botulinum toxin A-injections 6 months before enrolment.

The Sample was stratified blindly and then divided into 2 groups:

1- CIMT + AOT group, which contains 22 participants.

2- CIMT + placebo group, which also contains 22 participants.

Study Design:

The study design is RCT and it is appropriate for this purpose.

Data collection

The data was collected by the authors during the day camp where the study
was held. The steps of data collection were all clear and mentioned in the
article.

Instrumentation:

Brain Imaging and neurophysiological evaluation were performed before

and after the study.

Assisting Hand Assessment (AHA), Modified Ashworth Scale (MAS), the

8-point ordinal scale of the Medical Research Council, Jamar®
dynamometer, Melbourne Assessment 2 (MA2), Jebsen-Taylor Hand
Function test, Tyneside Pegboard Test, ABILHAND-Kids and the Children's
Hand-use Experience Questionnaire (CHEQ) were used by y a trained
physiotherapist blinded to group-allocation and time-point evaluation to
assess the children before and after the application of the intended therapy.
The validity and reliability of all assessment instruments were proved using
data from the literature to support their choice.

Data analysis:

The method of data analysis was not mentioned in the article.

Result:
The tables were clear; the figures were illustrative and analytically
presented, and all the collected data were tested and taken into consideration.

Results were presented and can be easily explored and understood by any
other researcher.

Discussion:
It contains a clear statement that answers the research question, that a
combination treatment between AOT and CIMT made an improvement on
UL for uCP child, and children with poorer hand function have shown more
improvement after the combined approach CIMT+ AOT than their peers
with better hand functions.

Conclusion:
It was a well-written summary of the whole work, and the whole points were
clear.

Bibliography:
All citation list is included in the reference list.

All references are up to date.

Funding:
This research is funded by the Fund Scientific Research Flanders and by the
Special Research Fund.

Ethical Issues:
The study was conducted at KU Leuven and was approved by the Ethics
Committee of the University Hospitals Leuven (S56513) and registered at
www.clinicaltrials.gov (ClinicalTrials.gov identifier: NCT03256357). All
children agreed to participate, and their parents or caregivers signed the
informed consent.

Summary:
The research purpose was mentioned and discussed all over the study.

The sample size was small in comparison to the prevalence of uCP in Leven,
as according (Depoortere & Winter, 2018) about 0.6 –0.8 per 1000 infants in
Leven suffer from uCP.

The research was purposeful as a way to find a safe conservative easy

intervention to improve the UL activity of the hemiplegic child.

The study is worth being replicated with a larger sample size.

I recommend this paper to Physiotherapists as well as Occupational
therapists to apply this technique during their sessions.

References:
1- Depoortere, M., & Winter, M. (2018). Movement Analysis of the Upper Limb in
Children With Unilateral Cerebral Palsy : Wrist Flexion and Extension, 2016–2018.
Retrieved from https://lib.ugent.be/fulltxt/RUG01/002/479/805/RUG01-
002479805_2018_0001_AC.pdf
2- Simon-Martinez, C., Mailleux, L., & Hoskens, J. (2020). Randomized controlled trial
combining constraint-induced movement therapy and action-observation training in
unilateral cerebral palsy: clinical effects and influencing factors of treatment response.
Therapeutic Advances in Neurological Disorders, 13, 1–13.