Is there evidence to support the use of constraint-induced therapy to improve the quality or quantity of upper extremity function of a 2 ½-year-old girl with congenital hemiparesis? If so, what are the optimal parameters of this intervention?

Abstract

The purpose of “Evidence in Practice” is to illustrate how evidence is gathered and used to guide clinical decision making. This article is not a case report. The examination, evaluation, and intervention sections are purposely abbreviated. A 28-month-old girl came to our physical therapy department with left-sided spastic hemiparesis, the result of a right cerebrovascular accident (CVA) in utero. Although she had delays in gross and fine motor development because of her hemiparesis, her cognitive and language development were typical for her age. Spontaneous use of her left upper extremity (UE) was markedly impaired in both quantity and quality of movement; however, she was able to use the left UE with prompting when she was given a 2-handed task (eg, holding a “sippy” cup with handles, holding a big ball with 2 hands) or when her right UE was therapeutically constrained. The child’s parents were well educated and well versed in therapeutic opportunities for improving left UE function, and they approached our university through their primary physical therapist to investigate the opportunity of involving their daughter in a student research project on pediatric constraint-induced therapy (PCIT). Through their support and information network, they had heard many anecdotal success stories related to the use of PCIT with children with sensory and motor impairments in the UE, and they were excited at the prospect of their daughter receiving this intervention. They contacted researchers conducting controlled clinical trials on PCIT in Alabama and New York. They put their child on a waiting list for a program at a university conducting PCIT clinical trials, but they recognized many drawbacks to attending this program, including the financial burden and the need to leave their home. The child was without any major medical complications or procedures since her diagnosis at 6 months of age. Upon diagnosis, …