The efficacy of combining constraint induced movement therapy and action observation training on upper limb function and performance in patient with hemiplegic upper limb: structure review

Abstract

Abstract Background Upper limb hemiplegia is a limiting condition associated with functional and performance deficits that may lead to disability. The use of constraint-induced movement therapy (CIMT) is increasing common in targeting the hemiplegic limb, while it has been proposed that combining CIMT with action observation therapy (AOT) can yield additional benefits. Objective To evaluate the effectiveness of CIMT alone or in combination with AOT on function and performance in patients with upper limb hemiplegia. Methods A systematic search process was conducted using online journal databases CINAHL, EMBASE, PEDro and PubMed. Inclusion criteria were randomised controlled trials published in the past ten years (2011-2021), a focus on patients with upper limb hemiplegia, and the use of CIMT in combination with AOT versus CIMT alone. Studies were appraised using the PEDro critical appraisal tool and narrative synthesis was completed for the results of all studies. Results The systematic search process identified three studies of relevance. These studies showed that combined CIMT and AOT was associated with positive clinical outcomes for performance and function in both children and adults with upper limb hemiplegia secondary to cerebral palsy or stroke. Additional benefits of combined therapy over CIMT alone included some effects on activities of daily living, function in those with poorest baseline function, and specific tasks, although this varied across studies. 9 Conclusion Combined CIMT and AOT for upper limb hemiplegia is associated with function and performance improvements compared to baseline status. Combined therapy is at least as effective as CIMT alone, with some potential additional benefits.