Comparison of Modified ConstraintInduced Movement Therapy (mCIMT) Hand Arm Bimanual Intensive Training and Mirror Therapy to Improve Upper Extremity Function in Children with Hemiplegic Cerebral Palsy: A Doubleblinded Randomised Clinical Trial

Introduction: Hemiplegic Cerebral Palsy (CP), a non-progressive neurological disorder resulting from early brain injury, leads to unilateral motor deficits, predominantly impacting Upper Extremity (UE) function. Characterised by limited pincer grasp and wrist extension due to spasticity and learned non-use, this impairs daily activities such as play and self-care, thereby reducing Quality Of Life (QOL). Need of the study: In children with hemiplegic CP, impaired UE function affects independence and QOL, prompting the need for advanced interventions beyond traditional therapies. Techniques such as modified Constraint-Induced Movement Therapy (mCIMT), Hand-Arm Bimanual Intensive Training (HABIT), and mirror therapy differ in their approaches to improving outcomes related to learned non-use and central nervous system plasticity. Current evidence on UE interventions is often rated low due to a scarcity of high-quality comparative trials, underscoring the necessity for a well-designed trial to determine the most effective technique for enhancing UE movement quality. Aim: To compare the effects of mCIMT, HABIT, and mirror therapy on UE function in children with hemiplegic CP. Materials and Methods: A double-blinded Randomised Controlled Trial (RCT) will be conducted from January 2023 to January 2026 at Dr Vithalrao Vikhe Patil Foundation’s College of Physiotherapy, Ahilyanagar, special schools, and private clinics. Thirty-three children with hemiplegic CP, aged 3-12 years, meeting inclusion criteria, will be randomised into three groups (n=11 each): Group-A (mCIMT), Group-B (HABIT), and Group-C (mirror therapy). Interventions will be administered for five days/week for four weeks, alongside conventional therapy, with pre- and post-assessments at two and four weeks using the Quality of Upper Extremity Skills Test (QUEST). Data will be analysed with repeated measures Analysis of Variance (ANOVA) or Kruskal-Wallis tests at a 0.05 significance.