What is the evidence-based approach to improving upper-extremity function in unilateral CP?

• A. Constraint-induced movement therapy (CIMT) for the affected arm and bimanual training (HABIT)
• B. Strengthening for all four limbs equally
• C. Surgical release procedures
• D. Pharmacologic muscle relaxants

Answer: (A)

Focusing on use-dependent, task-specific training of the affected hand yields the strongest improvements in unilateral CP. Constraint-induced movement therapy forces the child to use the affected arm by restricting the non-affected hand, addressing learned nonuse and promoting neural reorganization that supports better spontaneous use of the hand. Pairing this with bimanual training (HABIT) provides intensive practice of coordinated, two-handed tasks, improving real-world hand function and the ability to use both hands together.

This combination targets both unimanual ability and bimanual coordination, with a solid evidence base showing durable gains in daily hand use and functional performance. Broad strengthening of all four limbs doesn’t specifically drive the necessary functional changes in the affected hand, and while it can aid overall function, it isn’t as effective for improving hand use. Surgical releases and pharmacologic muscle relaxants may help with tone or range of motion in certain cases but don’t produce the same level of functional hand-use improvements that intensive, task-focused training achieves.