MODIFIED CONSTRAINT INDUCED MOVEMENT THERAPY FOR CHILD WITH HEMIPLEGIA

Abstract

Background & Purpose: CIMT has been a popular intervention under investigation in the adult stroke population. This intervention improves upper extremity function by restraining the non-involved arm in a hemiplegic patient and forcing the use of the involved arm in functional tasks. The practice sessions are intense with 6 hours of intervention a day for 2 weeks. CIMT is beginning to be used in the clinic with the pediatric population. Determining an effective way to deliver the intensity of practice prescribed by the experimental protocols is challenging. The purpose of this case study is to describe a modified delivery of CIMT (mCIMT) in a pediatric patient with hemiplegia and the resultant outcomes. Case Description: The subject of this case study was 4.6 years old with a history of hemiplegia of early onset at 4 months of age. A long arm cast was placed on the non- involved upper extremity with the elbow in 90 degrees of flexion and the hand, wrist and fingers in neutral included in the cast for a period of 26 days. The subject received formal PT and OT totaling 6 sessions/week (approximately 45 minutes each). To increase the intensity of practice PT students were trained to provide practice sessions in the home 6 days/week, 2 hours/day (totaling 32 hours). The family provided approximately 2-4 hours of practice/day by incorporating practice into their everyday activities and meal times. The subject received an average of 5.5 hours of structured practice a day for 26 days combined home and clinic. Outcomes: “Meaningful” improvement was determined by comparing changes to SEM. Improvements on subtest 8: Upper-Limb Speed and Dexterity of the Bruininks-Oseretsky Test of Motor Proficiency were meaningful (SEM = 2) with a standard score of 5 at pretest to 11-post intervention. Peabody Developmental Motor Scale; Fine Motor section improved from a FM quotient of 94 to 106 with the standard score (SS) = 18 at pretest and SS = 22 at post-test. Extrinsic finger flexion strength improved from 2 to 4 pounds and intrinsic pinch strength improved from 1 to 4 pounds both measured with dynamometer. Discussion: This case study demonstrated a meaningful change in fine motor function and strength for a child with hemiplegia after mCIMT. A modified delivery of CIMT may prove to be an effective way to provide the intensity of practice to affect a functional change in children with hemiplegia. Further investigation into the delivery of intense practice interventions, intervention protocols, and appropriate outcome measures to document change are necessary in the pediatric population.