IMPACT OF CONSTRAINT-INDUCED MOVEMENT THERAPY (CIMT) VS. ELECTROMYOGRAPHIC (EMG) BIOFEEDBACK ON UPPER LIMB MOTOR RELEARNING IN CEREBRAL PALSY

Background: Upper limb motor impairments in children with cerebral palsy (CP), particularly hemiplegic types, limit functional independence and reduce quality of life. Constraint-Induced Movement Therapy (CIMT) and Electromyographic (EMG) Biofeedback are two evidence-based rehabilitative approaches that aim to improve motor outcomes. CIMT facilitates cortical reorganization through intensive, task-specific training of the affected limb, while EMG Biofeedback supports motor learning via real-time visual or auditory feedback on muscle activation. Comparative evidence regarding their effectiveness in pediatric CP remains sparse. Objective: To compare the effects of CIMT and EMG Biofeedback on upper limb motor function, spasticity, and functional hand use in children with spastic hemiplegic CP. Methods: A randomized controlled trial was conducted at a tertiary pediatric rehabilitation center involving 60 children aged 6–12 years with spastic hemiplegic CP (GMFCS Levels I–III). Participants were randomized into two groups: CIMT (n = 30) and EMG Biofeedback (n = 30). Both groups received 2-hour sessions, 5 days a week for 4 weeks. The CIMT protocol included mitt restraint and task-specific training, while the EMG group received guided selective muscle activation training using surface electrodes. Primary outcomes were the Melbourne Assessment of Unilateral Upper Limb Function (MA2), Modified Ashworth Scale (MAS), and Assisting Hand Assessment (AHA). Evaluations were conducted at baseline and after 4 weeks. Results: At baseline, no significant differences were observed between groups (p > 0.05). Post-intervention, the CIMT group demonstrated greater improvements in MA2 scores (52.3 ± 6.8 to 71.2 ± 7.4) compared to EMG Biofeedback (51.9 ± 7.2 to 61.8 ± 8.1; p < 0.001). Spasticity reduced more in CIMT (MAS mean change: −1.5 ± 0.6) than EMG (−0.8 ± 0.5; p < 0.001). AHA scores improved significantly in the CIMT group (45.6 ± 5.5 to 62.3 ± 6.1) versus the EMG group (45.2 ± 5.9 to 54.8 ± 6.7; p < 0.001). Conclusion: CIMT resulted in significantly greater improvements in upper limb function, spasticity reduction, and hand use than EMG Biofeedback. These findings support prioritizing CIMT as a primary rehabilitation strategy in children with hemiplegic CP, with EMG Biofeedback as a supplementary option when CIMT is not feasible.