Hemiplegia is one of the common types of cerebral palsy, accounting for 14.4%-38% of all cerebral palsy types. The main disabling symptom is unilateral hand and arm dysfunction, with impaired sensation and movement. Encephalitis, traumatic brain injury, and cerebrovascular lesions are also common causes of hemiplegia in children. Children with hemiplegia usually use the healthy upper limb in their daily activities, resulting in developmental disuse and neglect of the affected upper limb, which exacerbates the dysfunction of the affected side. Constraint-Induced Movement therapy (CIMT) or Forced use therapy is a recent rehabilitation method that restricts the use of the healthy side while intensifying the use of the affected limb to improve the spontaneous use of the affected limb and prevent the occurrence of neglect on the affected side. This paper briefly describes the history and theoretical basis of CIMT, and reviews the literature on the clinical application of CIMT in the rehabilitation of children with hemiplegia. Taub surgically removed sensory afferents from one forelimb of monkeys, and the monkeys no longer used that forelimb, a phenomenon called “Learned nonuse (LNU)”; while restricting the intact forelimb for a few days or weeks, the monkeys were not able to use that forelimb. This phenomenon is called “Learned nonuse (LNU)”, while restricting the intact side of the forelimb for a few days or weeks and training the denervated afferent side of the forelimb, especially the so-called “shaping”, gradually the use of that side of the limb will reappear. In humans, after CNS injury, brain function and motor activity are inhibited, and on the one hand, the atrophy of the cortical representation area causes a decrease in the movement of the innervated limb and an increase in motor effort; on the other hand, the pain, failure, and incoordination of movement of the affected limb cause the patient to refuse to use the affected limb, and the compensatory behavior pattern on the healthy side is positively reinforced. Taub et al. designed CIMT treatment accordingly, which was first applied to functional training of the upper limb after stroke and later extended to medical rehabilitation of cerebral palsy, chronic hemiplegia after traumatic brain injury, aphasia, and simple hand dystonia. The efficacy mechanism of CIMT involves two aspects: on the one hand, the reversal of LNU phenomenon after neurological injury, and on the other hand, use-dependent cortical reorganization, both of which promote each other’s efficacy. Use-dependent cortical reorganization has been demonstrated in patients with hemiplegia treated with CIMT 9-39 months after brain injury, where functional magnetic resonance (fMRI) showed new activation in the contralateral motor area/premotor area cortex or increased activation in the ipsilateral motor cortex and supplementary motor area while motor function in the hemiplegic limb improved significantly, and this activation persisted at 6 months post-treatment. This activation persisted during the 6-month follow-up period after treatment, suggesting that altered motor cortex plasticity is the neural basis for the efficacy of CIMT. The CIMT treatment program is a prescriptive, integrative, and systemic treatment program. It consists of 3 main components: 1) repetitive task-oriented training of the affected limb for 6 hours per day for 2-3 weeks; 2) transfer of the acquired skills to a realistic environment by applying a “transfer package” of persistence-enhancing behavioral methods; and 3) restriction of the healthy side and forcing the patient to use the affected side. Repetitive task-directed training was performed under the supervision of the therapist for 6 hours a day. The therapist should consider when selecting the training content for the patient: 1) the movement of the joint with the heaviest deficit; 2) the movement of the joint that the therapist believes has the greatest potential for recovery; and 3) the movement that the patient prefers to take during the operation. The therapist should give the patient appropriate rest during training; record the intensity of training (number of attempts/time); interact with the patient, including: giving feedback on the patient’s operation results and providing expertise (e.g., the number of repetitions that should be made within a certain time period); prompting, facilitating, and improving the patient’s movement; demonstrating the operation to the patient; and mental or material rewards to increase motivation and maximum effort in training. One of the most important goals of therapy is to apply the learned skills in real-life situations. The adherence-reinforcement strategy is a “transfer package” technique to achieve this goal by giving the patient the responsibility to use the affected limb for daily functional tasks without the supervision of a therapist, without endangering safety Gloves are worn as often as possible, and caregivers can provide appropriate assistance to reduce the patient’s transitional struggles and make it easier to perform as many activities of daily living as possible. The main components of adherence-reinforcement behavioral training are monitoring, problem solving, and behavioral contracting. Monitoring is a series of daily Motor Activity Log (MAL) and family diary to observe and record the operation of the target behavior, including the activity mode, time, frequency, effort, and psychological response, etc., and analyze them together with the patient to improve the sense of responsibility, persistence, and completion of the training; problem solving is to let the patient recognize the hidden obstacles and select potential solutions. discovering potential solutions, selecting and implementing solutions, evaluating the results after implementation, and selecting alternative solutions if needed; behavioral contracting involves having the patient write out daily routines for normal life, and the therapist working with the patient to select which tasks should be performed and in what manner, in a written contract for the patient to implement in the home. Others such as caregiver contracts involve: a) promoting the caregiver’s understanding of the treatment program; b) instructing the caregiver to help appropriately; c) improving the patient’s safety; home skill assignments encourage the patient to try the affected limb to participate in ADLs by grouping common ADL activities in the patient’s home life according to room (kitchen, bath, bedroom, office) and having the patient choose 10 of them and record them on an assignment sheet Take them home for at least 30 minutes of practice. Encourage patients to implement trained self-efficacy enhancement strategies, including work achievement, alternative experiences, verbal persuasion, emotional arousal, etc. Restriction The treatment plan usually requires restriction of the healthy upper extremity, i.e., restraining the healthy upper extremity with a suspension belt or protective safety glove to prevent the patient from succumbing to the strong desire to use the healthy upper extremity. The term “Constraint” refers not only to the use of some kind of physical restraint, but also to the restriction of the opportunity to use the healthy side for functional activities. In recent years, the preferred physical restraint has been a protective finger glove that prevents the patient from using the fingers while the upper extremity can be extended for balance protection. Restriction on the able-bodied side up to 90% of the working time is required. Taub et al. developed a device called AutoCITE (automated CI therapy extension) to partially automate CIMT, A work chair. The computer provides a step-by-step demonstration to guide the patient through the entire exercise, and the patient can select an operation via two buttons on the monitor, pull the table out after selection, and lock it in the lap. The eight task activities are all commonly used in current CI therapy and include: reaching, tracking, pegboard, supination/reverse palm, studding, bow-ring manipulation, finger-tap, and object-throw. therapy is equally effective. CIMT in children with hemiplegic cerebral palsy The traditional treatments for hemiplegic cerebral palsy include proprioceptive neuromuscular facilitation (PNF) training, neurodevelopmental therapy, neuroelectric stimulation, etc. As a new physical intervention, CIMT has been used in the treatment of children with hemiplegic cerebral palsy. Taub et al. randomly divided 18 children with hemiplegic cerebral palsy aged 7-96 months into a CIMT treatment group and a conventional treatment group, using blinded laboratory assessment and parental grading at home to assess the children’s upper limb functional skills before, immediately after, and 3 weeks after treatment, respectively, with a 6-month follow-up. The results showed that those treated with CIMT achieved more significant motor skill grading in the hemiplegic side of the limb, increased spontaneous use, and improved quality of life than the conventional treatment group, and the efficacy was maintained for more than 6 months. Due to age and functional developmental differences, the original CIMT approach for adults is more difficult to implement in children, and therefore needs to be modified for clinical use as a child-friendly CI therapy. The treatment is conducted in small groups of 2-3 people, providing social interaction, imitation, and rewards, with one therapist per child, and organized in a child-friendly manner whenever possible. friendly manner so as to be accepted by most children. The efficacy of CIMT therapy in improving motor effectiveness and functional limitations in the environment of children with hemiplegic cerebral palsy was found to be non-age-dependent in a controlled study of children in different age groups.Eliasson et al. used a modified CIMT treatment that set up the CIMT treatment based on the principles of motor learning and stimulated learning in play, and also achieved significant efficacy, as the treatment was set up according to the child’s All children were receptive to the treatment because it was tailored to their abilities and interests. The duration of treatment is usually set at 6 hours and the course of treatment is set at 2-3 weeks. However, in pediatric patients, it is difficult to adhere to the 6 hours of focused training per day, so the daily training time can be shortened in clinical use and the duration of treatment can be extended from 10 days to several months. The methods of limitation on the healthy side include tubular casts, splints, suspension straps, fingerless gloves, etc., while the latter two are most commonly used. Children and adults also differ in the methods used to assess outcomes. Adults usually use the Wolf Motor Function Test (WMFT) and the Motor Activity Log (MAL). In children with hemiplegic cerebral palsy, the Jebsen-Taylor Hand Function Test, the Assisting Hand Assessment (AHA), and the Peabody Developmental Motor Scales (PDMS) are used to assess outcomes. V. Limitations of CIMT for Cerebral Palsy Children with hemiplegic cerebral palsy often have varying degrees of sensory deficits in the involved and non-involved limbs, especially stereo and proprioceptive deficits, which affect motor function and motor control, resulting in difficulties in hand coordination. The hemiplegic side of the upper extremity exhibits time consuming, laborious, and slowed movements, limited ROM especially with inadequate shoulder flexion, limited elbow extension, inadequate forearm rotation, and increased compensatory trunk flexion. In severe cases, anterior rotation contracture of the forearm with flexion contracture of the elbow is observed. Although CIMT can significantly improve the unassisted function of the affected side in children with hemiplegic cerebral palsy and is gaining attention in pediatric rehabilitation, there are limitations to this therapy; Charles et al. found that although the effectiveness of upper extremity movements as well as dexterity, frequency of upper extremity use, and quality of movement were significantly improved in the treated group, improvements in muscle strength, sensory ability, and muscle tone were not significant. Therefore, on the one hand, the implementation of rehabilitation using CIMT requires the therapist to carefully identify the characteristics of the dysfunction in order to explore the maximum functional potential; on the other hand, other treatments to improve muscle strength, sensory ability, and muscle tone should be used in conjunction. Hand-arm bimanual intensive training (HABIT) is another new treatment that retains the 2 main elements of pediatric CIMT. These are: strengthening exercises and child-friendliness, which can address the limitations of CIMT therapy and improve bilateral coordination. In summary, CIMT therapy is a prescriptive, integrative, and systemic treatment program whose mechanisms of action include reversal of learned disuse after neurological injury and use-dependent cortical reorganization, and is effectively used not only in the treatment of adult hemiplegia, but also has clear efficacy in children with hemiplegic cerebral palsy, which should be appropriately modified for pediatric application due to age and developmental characteristics in a child-friendly Due to the age and developmental nature, pediatric application should be appropriately modified to ensure smooth implementation, supplemented by neurodevelopmental therapies, PNF, and muscle tone and strength training as appropriate.