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

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.