The comprehensive review of upper-limb therapies for unilateral cerebral palsy by Sakzewski et al is particularly timely because this area has recently experienced a large increase in publications. The article by Sakzewski et al cites previous work indicating that the traditional approach of neurodevelopmental treatment is not efficacious. The authors found that 2 more recent approaches to physical rehabilitation (constraint-induced movement therapy [CIMT] and bimanual therapy) are superior to conventional care.

Two components are common to all forms of CIMT: (1) intensive training of the more-affected arm for multiple sessions; and (2) restraint of the less-affected arm for varying periods of time in different experiments/clinics, thereby forcing use of the more-affected arm. In the protocol referred to as classic CIMT in Sakzewski et al, there are 2 additional components: (3) training by the behavioral technique termed “shaping”2–5  and (4) use of a “transfer package” of...

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