Effectiveness of Modified Constraint-Induced Movement Therapy Delivered Via Telerehabilitation in Children With Unilateral Cerebral Palsy: A Prospective Randomized Controlled Trial

The AHA is a test that measures how patients with upper extremity dysfunction, such as hemiplegic CP or congenital brachial plexus injury, use their affected hand in conjunction with their unaffected hand during two-handed play. It was first validated in children aged 18 months to 5 years (Small Kids AHA), and then two play tables were created for children aged 6 to 12 years (School Kids AHA). In this assessment method, a camera records the child performing tasks and playing with both hands. This assessment method can be administered by healthcare professionals who have completed the training and received certification. The test consists of two stages: first, the assessor (therapist, physician) sits opposite the child, and an environment is prepared using age-appropriate toys from the AHA kit to enable the child to perform all upper extremity functions using both hands. A camera positioned behind the assessor records this process.

ABILHAND-Kids is a scale that assesses the extent to which children with cerebral palsy can use their manual skills in daily living activities such as self-care, and the difficulties perceived by parents during these activities.

The Jebsen-Taylor Hand Function Test (JFTT) is a standardized performance test developed to assess unimanual daily skills. In this test, children are asked to perform tasks such as grasping, releasing, and moving objects at varying levels of difficulty as quickly and accurately as possible. The assessment time is recorded in seconds.

In our study, ROM in the affected extremity was measured separately using a joint goniometer, both actively and passively, for finger flexion/extension, wrist flexion/extension, supination/pronation, elbow flexion/extension, and shoulder flexion/extension/abduction/adduction/internal rotation/external rotation.

Grip strength was measured separately in both upper extremities using a Baseline® Smedley spring dynamometer (child, 110 lb, USA).

The standard procedure outlined by Mathiowetz et al. was followed during the assessment: three maximum voluntary grips were performed for each hand. The average of these three measurements was taken, and the results were recorded in kilograms of force (kgF).

Muscle tone was assessed in five major muscle groups in the affected upper extremity. The Modified Ashworth Scale (MAS) was used, and muscle tone was graded from 0 (normal) to 4 (significantly increased).

The muscle groups assessed were: elbow flexors, elbow extensors, wrist flexors, wrist extensors, and finger flexors.

The Children's General Health-Related Quality of Life Scale (KINDL-R) is a self-report scale developed to assess the health-related quality of life of children and adolescents. It is available in three versions to suit different age groups: the Kiddy-KINDL-R (interviewer-administered version) for children aged 4-7, the Kid-KINDL-R for children aged 8-12, and the Kiddo-KINDL-R for adolescents aged 13-16. In addition, two parent forms are available that allow families to indirectly assess the quality of life of younger children (ages 4-7) and older children and adolescents (ages 8-16).