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Methods of constraint-induced movement therapy for children with hemiplegic cerebral palsy: Development of a child-friendly intervention for improving upper-extremity function

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Abstract

Gordon AM, Charles J, Wolf SL. Methods of constraint-induced movement therapy for children with hemiplegic cerebral palsy: development of a child-friendly intervention for improving upper-extremity function. Arch Phys Med Rehabil 2005;86:837-44.

We delineate the methodology for constraint-induced movement therapy (CIMT) modified for children with hemiplegic cerebral palsy (CP) and describe important considerations that need to be made when testing this intervention in children. The resulting intervention evolved from piloting and testing it with 38 children with hemiplegic CP who were between the ages of 4 and 14 years. Thirty-seven successfully completed the treatment protocol. The intervention retains the 2 major elements of the adult CIMT (repetitive practice, shaping) and was constructed to be as child-friendly as possible. It involves restraining the noninvolved extremity with a sling and having the child engage in unimanual activities with the involved extremity 6 hours a day for 10 days (60h). Specific activities are selected by considering joint movements with pronounced deficits and improvement of which interventionists believe have greatest potential. The activities are chosen to elicit repetitive practice and shaping. The intervention is conducted in groups of 2 to 3 children to provide social interaction, modeling, and encouragement. Each child is assigned to an interventionist to maintain at least a 1:1 ratio. CIMT can be modified to be child-friendly while maintaining all practice elements of the adult CIMT. The modified therapy is tolerated by most children. Further modifications will likely be required to hone in on the specific components of the intervention that are most effective before applying them to children who are most likely to benefit.

Section snippets

Overview

Our initial effort to adapt CIMT for children began in 1997, and the method described below is based on piloting and testing with 38 children between the ages of 4 and 14 years. The criteria for participation were: (1) congenital hemiplegia with a difference of at least 50% between the 2 limbs on timed motor tasks of the Jebsen-Taylor Test of Hand Function,36 and (2) the ability to extend the wrist at least 20° and fingers 10° from full flexion.37 Of the 38 children, 37 successfully completed

Suitability of CIMT for children with hemiplegia

Our methodology represents our best judgment, prior clinical and experimental experience working with children with hemiplegic CP, knowledge acquired from the adult CIMT literature, and the testing of the 38 children. The high intervention completion rate suggests that the approach is child-friendly and, in our experience, the children enjoy participating. Despite the successful application and promise of the intervention and our attempts to make it child-friendly, it is still taxing. It

Conclusions

The outlined methodology is the first effort to describe the application of CIMT with children in more detail than is possible in data-based articles. It attempts to carefully define CIMT, to clarify that it is not simply forced use or traditional PT and OT with a restraint. Overall, we have demonstrated that CIMT can be successfully modified for 4- to 14-year-old children with hemiplegic CP. The modified intervention maintains all practice elements of the adult CIMT (repetitive practice,

Acknowledgment

We thank the interventionists who have volunteered their time. We thank Jennifer Schneider for assistance with this manuscript, and Sarah Blanton and Lena Krumlinde-Sundholm for helpful comments.

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    Supported by the National Center for Medical Rehabilitation Research, National Institute of Child Health and Human Development (grant no. HD 40961).

    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.

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