Importance for CP Rehabilitation of Transfer of Motor Improvement to Everyday Life

Abstract

* Abbreviation: CIMT — : constraint-induced movement therapy The comprehensive review of upper-limb therapies for unilateral cerebral palsy by Sakzewski et al1 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,1 there are 2 additional components: (3) training by the behavioral technique termed “shaping”2–5 and (4) use of a “transfer package” of techniques to facilitate transfer of treatment gains from the clinic to everyday life.2,3,6 In bimanual therapy, training tasks involve use of both upper extremities: the less-affected as well as the more-affected arm. There are no standard procedures in conventional upper-extremity rehabilitation; the range of procedures includes unilateral or bilateral task practice that is usually … Address correspondence to Edward Taub, PhD, CPM 712, 1720 2nd Ave South, University of Alabama at Birmingham, Birmingham, AL 35294-0018. E-mail: etaub{at}uab.edu