Which therapy has strong evidence for improving upper extremity function in hemiplegic CP?

• A. Constraint-induced movement therapy (CIMT)
• B. Botox injections
• C. Mirror therapy
• D. Electrical stimulation

Answer: (A)

Constraint-induced movement therapy works because it uses the affected hand in a highly repetitive, task-focused way to drive motor learning and cortical changes. In children with hemiplegic cerebral palsy, there’s often a tendency to rely on the nonparetic hand, which can limit the use and improvement of the affected hand. By restricting the unaffected hand and providing intensive practice of functional tasks with the affected hand, CIMT promotes use-dependent plasticity, strengthens the neural pathways for skilled hand movements, and improves spontaneous use of the impaired limb. Clinically, this translates to better hand function and improved performance in daily activities and play.

Botox injections can reduce spasticity temporarily, which may help movement, but they don’t consistently produce long-term functional gains by themselves without targeted therapy. Mirror therapy and electrical stimulation have supportive evidence, but the strongest, most consistent improvements in upper-extremity function for hemiplegic CP come from CIMT when it’s implemented with appropriate task practice and intensity.