# Mapping the Comparative Effectiveness of Modified Constraint-Induced Movement Therapy, Hand-Arm Bimanual Intensive Training, and Mirror Therapy for Upper Extremity Rehabilitation in Children With Hemiplegic Cerebral Palsy: A Scoping Review

## TL;DR

This review compares three therapies for improving upper limb function in children with hemiplegic cerebral palsy, finding each has unique benefits but more research is needed.

## Contribution

The study provides a comparative overview of three rehabilitation therapies for hemiplegic CP, highlighting their distinct effectiveness and safety profiles.

## Key findings

- All three interventions improved upper limb function and bimanual coordination without adverse effects.
- mCIMT showed better unimanual outcomes, HABIT improved bimanual coordination, and mirror therapy enhanced dexterity and spasticity.
- Comparative trials were limited, and protocol heterogeneity hindered definitive rankings.

## Abstract

Hemiplegic cerebral palsy (CP) usually impacts upper extremity function, leading to reduced participation and independence. Evidence-based treatment approaches such as modified constraint-induced movement therapy (mCIMT), hand-arm bimanual intensive training (HABIT), and mirror therapy have demonstrated neuroplasticity; however, direct comparisons among these interventions remain limited. Hence, this scoping review addresses evidence on the comparative efficacy, safety, and outcomes of these interventions in children with hemiplegic CP, mainly for the upper limb function. A literature search was performed in ScienceDirect, PubMed, and Google Scholar with specified keywords from January 2020 to September 2025. From 4,391 records, 14 high-quality studies rated using the Mixed Methods Appraisal Tool that fulfilled the eligibility criteria were included. The findings reported that all the interventions improved bimanual performance, upper limb motor control, and participation, with no adverse effects and short-term gains. mCIMT showed better unimanual outcomes; HABIT approach demonstrated superiority in bimanual coordination; mirror therapy enhanced dexterity/spasticity, especially as an adjunct. Comparative trials were absent, with heterogeneous protocols limiting rankings. Hence, mCIMT, HABIT, and mirror therapy offer safe, effective options for upper extremity rehabilitation in hemiplegic CP, supporting personalized/hybrid approaches. Future multicenter RCTs with standardized dosing and long-term follow-ups are needed to address gaps in comparisons and equity.