Constraint-induced Movement Therapy Research Articles

Upper Limb Therapy for Infants and Young Children with Unilateral Cerebral Palsy: A Clinical Framework

Early detection and rehabilitation interventions are essential to optimise motor function in infants and young children with unilateral cerebral palsy. In this paper we report a clinical framework aimed at enhancing upper limb therapy for infants and young children with unilateral cerebral palsy during a sensitive period of brain development. We describe two major therapeutic approaches based on motor learning principles and evidence: constraint-induced movement therapy and bimanual therapy. These two therapies have demonstrated efficacy in older children and emerging evidence is available for their application to infants younger than 2 years of age. To provide clinicians with guidance as to when to implement these therapies, we discuss the key consideration when undertaking upper limb therapy programs. In addition, we describe the factors to consider when choosing which approach may be suitable for an individual child and family. Detailed strategies for implementing these therapies in infants and young children of different ability levels are given.

Young Children Benefit from Intensive, Group-Based Pediatric Constraint-Induced Movement Therapy.

This quasi-experimental study examined the effectiveness of an intensive, group-based pediatric constraint-induced movement therapy (pCIMT) program for young children. Thirty-five children aged 21 months to 6 years, with unilateral hemiparesis (HP), or weakness on one side of the body from varying etiologies, participated in a 4-week intensive, interprofessional, theme- and group-based pCIMT clinic program in the Midwest, United States. The program ran for 4 weeks with 3 h of therapy per day, 5 days per week with 3 weeks of 24 h casting for the unaffected arm, followed by 1 week of bimanual focus. Outcome measures included the Quality Upper Extremity Skills Test (QUEST), Assisting Hand Assessment (AHA), Canadian Occupational Performance Measure (COPM), and Pediatric Evaluation of Disability Inventory (PEDI). The participants statistically significantly improved the unilateral function of the HP arm in four of five QUEST variables (p < 0.009), bimanual coordination as measured by the AHA (p < 0.001), and some areas of occupational performance as measured by the COPM (p < 0.001) and PEDI (p < 0.05). This study revealed the intensive, group-based pCIMT clinic model was effective and feasible to implement with the support from various stakeholders.

Systematic Review and Meta-Analysis of Intervention Techniques in Occupational Therapy for Babies and Children with Obstetric Brachial Plexus Palsy.

(1) Background: Obstetric brachial plexus palsy (OBPP) is an unpredictable and unpreventable neurological injury, caused by shoulder dystocia during birth, that affects the brachial plexus and leads to motor and sensory deficits in the child's upper extremity. The limited literature on early therapeutic assessment of newborns with OBPP highlights a gap in specialized care that, if filled, could enhance decision-making and support timely treatment. The objective of this paper is to analyze the therapeutic intervention techniques used at an early stage and their functional impact, from the occupational therapy discipline in the treatment of the upper extremity in babies and children with OBPP. (2) Method: Systematic review design and meta-analysis. A systematic review is a comprehensive analysis of existing research on a specific topic, using rigorous methods to identify, evaluate, and synthesize studies. Meta-analysis, often part of a systematic review, combines results from multiple studies to identify overall trends and enhance reliability, providing a clearer summary of evidence. Articles that included pediatric patients (from birth to 12 years of age) with a diagnosis of OBPP were reviewed. The results of the techniques used were analyzed according to each study, with the scale or method of assessment considered by the study for the presentation of data. The articles were assessed for methodological quality using the "PEDro Validity Scale". (3) Results: A total of 2190 articles were found, with 108 analyzed and 22 fully meeting this study's standards. Fourteen had a quantitative design, while the others included clinical guidelines. The most statistically reliable intervention techniques were CIMT (constraint-induced movement therapy) and splinting (dynamic and static), with second-tier techniques like joint manipulation, NMES, early infant management education, and serial casting used when needed. This study focused on children from birth to eight years old, with assessment tools primarily measuring upper limb range of motion, external rotation, supination, and impairment levels, though bimanual activity assessment was less common. (4) Conclusions: The early implementation of the techniques that provide us with the most data are CIMT, splinting, NMES, and joint manipulation linked to health education for families. In second place, we have the use of TB infiltrations and serial casts, when the treatment of the previous techniques fails in some cases.

Effect of Constraint-Induced Movement Therapy and Mirror Therapy on The Patients with Subacute Stroke in Bangladesh

Background: Subacute stroke is a health-related problem that spans a period from two days to two weeks. A marked disability results from stroke causes remarkable burden on family and society. Objective: To find out the effectiveness of constraint-induced movement therapy (CIMT) and combined mirror therapy on patients with subacute stroke. Comparison of effectiveness in between combined therapy and CIMT. Materials and Methods: Eighteen patients with subacute stroke were enrolled and randomly divided into three groups: CIMT combined with mirror therapy group, CIMT only group, and control group. Two weeks of CIMT for 6 hours a day with or without mirror therapy for 30 minutes a day were performed under supervision. All groups received conventional occupational therapy for 40 minutes a day for the same period. The CIMT-only group and control group also received additional self-exercise to substitute for mirror therapy. Results: We performed the Fugl-Meyer assessment, which was 32.67±21.70 pre-treatment and 37.00±21.06 post-treatment with a p-value of 0.011, MRC muscle grading pre-treatment 3.01±2.78 and 3.21±1.35 post-treatment with a p-value of 0.107, and Modified Barthel Index pre-treatment 29.56±27.43 and 28.33±26.71 post-treatment with a p-value of 0.104. After two weeks of treatment, we had found that CIMT along with mirror therapy, had more impact on subacute stroke patients. Conclusion: Disability limitation following stroke should focused more. Among various treatment facilities CIMT shown promising result along with exercise and mirror therapy. Care-giver’s education, tele-rehabilitation facility, supervision of exercise will reduce hazard of attending hospital in small interval. Early initiation of rehabilitation program yield better results. KYAMC Journal Volume: 15, No: 01, April 2024: 33-39.

Comparison Of Bobath Technique And Constraint Induced Movement Therapy In Stroke Rehabilitation: A Systematic Review

Comparison Of Bobath Technique And Constraint Induced Movement Therapy In Stroke Rehabilitation: A Systematic Review

Effectiveness of Mirror Therapy, Electrical Stimulation, and CIMT in Restoring Upper Extremity Function after Stroke

Objective: This study aimed to compare the effectiveness of mirror therapy (MT), electrical stimulation (EMS) combined with MT, and Constraint-Induced Movement Therapy (CIMT) in improving upper extremity function among stroke survivors. Methodology: A randomized controlled trial was conducted involving n=45 stroke patients undergoing rehabilitation at Wah International Hospital. The inclusion criteria for the study required participants to be above 45 years of age, to have survived either an ischemic or haemorrhagic stroke, and to have at least 10° wrist extension. Participants were excluded if they had an implanted electrical device such as an artificial pacemaker, paresis instead of paralysis, hemiplegia due to causes other than ischemic or haemorrhagic stroke (such as trauma, tumor, or coordination problems), or impaired sensory integration. Participants were divided into three groups: EMS combined with MT, CIMT alone, and Mirror therapy alone. Treatment sessions were administered four times a week for three months. Outcome measures included the Fugl-Meyer Assessment Scale (FMA) and Motor Assessment Scale (MAS). Results: Analysis revealed significant improvements in upper extremity function across all groups. However, the CIMT group exhibited the most substantial enhancement, with a mean difference of -68.5 (p &lt; 0.05) on the FMA and -24.1 (p &lt; 0.05) on the MAS compared to the other groups. Conclusion: The findings highlight the superior efficacy of CIMT in improving upper extremity function among stroke survivors. Incorporating CIMT into rehabilitation protocols is crucial for optimizing outcomes in this patient population. Further research is warranted to explore the long-term benefits and optimal implementation strategies of CIMT in diverse rehabilitation settings

Translating acceptability to sustained delivery: Clinician and manager perspectives on implementing modified constraint-induced movement therapy in an early-supported discharge rehabilitation service.

Modified constraint-induced movement therapy (mCIMT) improves upper limb (UL) function after stroke. Despite up to one-third of stroke survivors being eligible, clinical uptake remains poor. To address this, a multi-modal behaviour change intervention was implemented across a large seven-site early-supported discharge (ESD) rehabilitation service. This study investigated the acceptability of mCIMT implementation within this ESD service and identified adaptations required for sustained delivery. This qualitative study was nested within a mixed-methods process evaluation of mCIMT implementation. Four focus groups (n= 24) comprising therapists (two groups), therapy assistants (one group), and allied health managers (one group) were conducted. Data were analysed using reflexive thematic analysis and mapped to the Theoretical Domains Framework (TDF). Consumers were not directly involved in this study; however, lived experience research partners have helped shape the larger mixed-methods implementation study. Four themes were generated and mapped to the TDF. Factors related to acceptability included interdisciplinary practice in sharing workloads (belief about capabilities), practice opportunities across a range of UL presentations (skills), clinician attitudes influencing patient engagement (optimism), time constraints (belief about consequences), and cognitive overload from multiple systems and processes (memory, attention, and decision-making processes). Factors facilitating sustained delivery included improving stroke survivor education (knowledge), sharing success stories across teams (reinforcement), manager facilitation (social/professional role and identity), and the perception that the ESD setting was optimal for mCIMT delivery (social influences). mCIMT was acceptable in the ESD service, with clinicians feeling a responsibility to provide it. Key adaptations for sustained delivery included ongoing training, resource adaptation, and enhanced patient and carer engagement. Successful implementation and sustained delivery of mCIMT in the ESD service could enhance UL function and reduce the burden of care for potentially hundreds of stroke survivors and their carers. Modified constraint-induced movement therapy (mCIMT) helps improve arm movement after a stroke. However, many stroke survivors do not get this therapy. To fix this, we started a program in a large home-based rehabilitation service. This study looked at how well mCIMT could fit into this service. We also wanted to know what changes were needed to make sure it was regularly provided. We held four group discussions with therapists, therapy assistants, and health managers. A total of 24 people took part. From these discussions, we found several important points. Therapists needed to work together as a team. They also needed to practice mCIMT to get better at delivering it. Therapists having a positive attitude would encourage more stroke survivors to take part. For long-term success, stroke survivors need better education about mCIMT. Managers need to encourage therapists to provide mCIMT. The rehabilitation service should also share their success stories about this therapy to encourage therapists to deliver it and stroke survivors to ask for it. Therapists enjoyed delivering mCIMT in the rehabilitation service. It worked better than other therapies to improve a stroke survivor's arm function. Because of this, they also felt it was their duty to offer mCIMT. Having ongoing training and better resources would help keep mCIMT going. If mCIMT can be provided regularly in this service, it could lead to better arm function and less care needed for many stroke survivors and their carers.

Effect of modified constraint-induced movement therapy along with bimanual massed practice on upper extremity functions in tetraplegics: a pilot study

Background and objectiveConstraint-induced movement therapy is a widely used rehabilitation program in the stroke population, but its application in spinal cord injury is limited. The objective of the study is to determine the feasibility of modified constraint-induced movement therapy (mCIMT) in incomplete tetraplegia exhibiting upper limb weakness and activities of daily living (ADLs) difficulty.MethodThis is a quasi-experimental one-group pilot study, consisting of 12 subjects diagnosed with incomplete tetraplegia. They received 2-h sessions of modified constraint-induced movement therapy of the weaker hand along with a 1-h session of bimanual massed practice, 5 days a week for 3 weeks. Apart from this, they were asked to do 3 h of constrained-induced movement therapy daily 5 days a week for 3 weeks at their home as a part of a home exercise program. Box and block test (BBT) and Spinal Cord Independence Measure version III (SCIM-III) were taken as the primary measure, and manual function test (MFT) and capabilities for upper extremity (CUE) were used as secondary measures to access hand functions and ADLs. Subjects were examined during pre-intervention and post-intervention.ResultsAfter 3 weeks of intervention, the mean change of the score for the trained hand showed significant changes in the scores of the box and block test (p = 0.03), manual function test (p = 0.02), SCIM-III (p = 0.03), and CUE (p = 0.02).ConclusionThis preliminary study revealed that modified CIMT may be a feasible and effective alternative for hand rehabilitation in incomplete tetraplegia.

Positive effects of lower extremity constraint-induced movement therapy on balance, leg strength and dual-task ability in stroke patients: a longitudinal cohort study.

To investigate whether high-intensity lower extremity constraint-induced movement therapy can improve balance, leg strength, and dual-task ability. A longitudinal cohort study in a real-world outpatient clinic. 147 community-dwelling participants in the subacute and chronic poststroke phases. Participants received lower extremity constraint-induced movement therapy for 6 hours/day during 2 consecutive weeks, including balance, strength, and functional training. The Berg Balance Scale (BBS), Single-Leg-Stance (SLS) bilaterally, one Repetition Maximum (1RM) in a leg press, symmetry of leg strength (Diff-1RM), Timed Up and Go (TUG), and the TUG Manual test were assessed before, after, and 3 months after lower extremity constraint-induced movement therapy. Compared with preintervention data, statistically significant improvements after lower extremity constraint-induced movement therapy (p < 0.001) were demonstrated for balance with an absolute value in BBS at 1.9 points (effect size 0.38) and SLS at 2.4 s (effect size 0.24), and for leg strength at 10.2 kg (effect size 0.54) for the affected leg. Diff 1RM decreased significantly at 5.8 kg (effect size 0.39) and improvements on dual-task ability at 2.7 s were significant (effect size 0.14). The effects persisted at the 3-month follow-up. High-intensity lower extremity constraint-induced movement therapy may be a feasible treatment option for middle-aged stroke patients to affect balance, leg strength, and dual-task ability positively in an out-patient clinical setting.

Effectiveness of intensive motor learning approaches from working on a vertical surface on hemiplegic children’s upper limb motor skills, a randomized controlled trial

Purpose This study compares the effect of intensive motor learning approaches on improving the quality of upper extremity skills in children with unilateral cerebral palsy (UCP) by working on vertical surfaces versus horizontal surfaces during rehabilitation sessions. Materials and methods Forty UCP children of both sexes were randomized into two equal groups. All participants received 60 min of intensive motor learning approaches three days/week for three successive months. These approaches included constraint-induced movement therapy (CIMT), in which children wore a splint or sling on the unaffected upper limb, as well as hand-arm bimanual intensive training (HABIT) that requires the use of both hands during specific play-based activities. The control group received training on a horizontal surface while the child sat in front of an elbow-height table while the study group (vertical surface training) sat or stood in front of a wall/mirror/board. The task requirements were graded to ensure success. Results Statistically significant differences were detected between the mean values of post-treatment of all scorers, with a greater percentage of improvement in favor of the study group. Conclusions This study revealed that working on a vertical surface improved upper limb motor skills more significantly than working on a horizontal surface.

Commentary on "Infant Modified Constraint-Induced Movement Therapy Paired with Neuromuscular Electrical Stimulation: A Feasibility Study".

Commentary on "Infant Modified Constraint-Induced Movement Therapy Paired with Neuromuscular Electrical Stimulation: A Feasibility Study".

Infant Modified Constraint-Induced Movement Therapy Paired With Neuromuscular Electrical Stimulation: A Feasibility Study.

To determine the feasibility of modified constraint-induced movement therapy (mCIMT) paired with neuromuscular electrical stimulation (NMES) for infants with asymmetrical hand function (AHF). Five infants received an experimental ABA design: (A1) 3weeks of our Standard AHF Care, (B) 3weeks mCIMT-NMES, and (A2) 3weeks of our Standard AHF Care. Parents tracked key data in a daily log, and infants were assessed 4 times using the Hand Assessment for Infants and Peabody Developmental Motor Scale-2. There was a high level of participant enrollment, visit frequency adherence, and compliance with the treatment protocol. No adverse events were reported. Mean Hand Assessment for Infants Both Hands measure scores changed more after mCIMT-NMES than after our Standard AHF Care. mCIMT-NMES is a feasible early intervention for infants with AHF at risk for unilateral cerebral palsy. A future study in a larger sample should examine the efficacy of mCIMT-NMES in this population.

Randomized Comparison Trial of Rehabilitation Very Early for Infants with Congenital Hemiplegia

To compare efficacy of constraint-induced movement therapy (Baby-CIMT) with bimanual therapy (Baby-BIM) in infants at high risk of unilateral cerebral palsy (UCP). Single-blind, randomized-comparison-trial that had the following inclusion criteria: (i) asymmetric brain lesion (ii) absent fidgety General Movements, (iii) Hammersmith Infant Neurological Examination below cerebral palsy cut-points, (iv) entry at 3 to 9 months corrected age (CA), and (v) >3 point difference between hands on Hand Assessment Infants (HAI). Infants were randomized to Baby-CIMT or Baby-BIM, which comprised 6 to 9 months of home-based intervention. Daily dose varied from 20 to 40-minutes according to age (total 70-89.2 hours). Primary outcome measure was the HAI post intervention, with secondary outcomes Mini-Assisting Hand Assessment and Bayley III cognition at 24-months CA. 96 infants (51 male, 52 right hemiplegia) born median at 37-weeks' gestation were randomized to Baby-CIMT (n=46) or Baby-BIM (n=50) and commenced intervention at a mean 6.5 (SD 1.6) months CA. There were no between group differences immediately post-intervention on HAI (mean difference [MD] 0.98 HAI units, 95% confidence interval [CI] 0.94-2.91; p=0.31). Both groups demonstrated significant clinically important improvements from baseline to post-intervention (Baby-BIM MD 3.48, 95%CI 2.09-4.87; Baby-CIMT MD 4.42, 95% CI 3.07-5.77). At 24 months, 64 infants were diagnosed with UCP (35 Baby-CIMT, 29 Baby-BIM). Infants who entered the study between 3 and 6-months CA had greater change in HAI Both Hands Sum Score compared with those who entered at ≥6-months CA (MD 7.17, 95% CI 2.93, 11.41, p=0.001). Baby-CIMT was not superior to Baby-BIM, and both interventions improved hand development. Infants commencing intervention at <6 months CA had greater improvements in hand function.

Design and application of pneumatic rehabilitation glove system based on brain-computer interface.

Stroke has been the second leading cause of death and disability worldwide. With the innovation of therapeutic schedules, its death rate has decreased significantly but still guides chronic movement disorders. Due to the lack of independent activities and minimum exercise standards, the traditional rehabilitation means of occupational therapy and constraint-induced movement therapy pose challenges in stroke patients with severe impairments. Therefore, specific and effective rehabilitation methods seek innovation. To address the overlooked limitation, we design a pneumatic rehabilitation glove system. Specially, we developed a pneumatic glove, which utilizes ElectroEncephaloGram (EEG) acquisition to gain the EEG signals. A proposed EEGTran model is inserted into the system to distinguish the specific motor imagination behavior, thus, the glove can perform specific activities according to the patient's imagination, facilitating the patients with severe movement disorders and promoting the rehabilitation technology. The experimental results show that the proposed EEGTrans reached an accuracy of 87.3% and outperformed that of competitors. It demonstrates that our pneumatic rehabilitation glove system contributes to the rehabilitation training of stroke patients.

Constraint-Induced Movement Therapy (CIMT) and Neural Precursor Cell (NPC) Transplantation Synergistically Promote Anatomical and Functional Recovery in a Hypoxic-Ischemic Mouse Model.

Cerebral palsy (CP) is a common neurodevelopmental disorder characterized by pronounced motor dysfunction and resulting in physical disability. Neural precursor cells (NPCs) have shown therapeutic promise in mouse models of hypoxic-ischemic (HI) perinatal brain injury, which mirror hemiplegic CP. Constraint-induced movement therapy (CIMT) enhances the functional use of the impaired limb and has emerged as a beneficial intervention for hemiplegic CP. However, the precise mechanisms and optimal application of CIMT remain poorly understood. The potential synergy between a regenerative approach using NPCs and a rehabilitation strategy using CIMT has not been explored. We employed the Rice-Vannucci HI model on C57Bl/6 mice at postnatal day (PND) 7, effectively replicating the clinical and neuroanatomical characteristics of hemiplegic CP. NPCs were transplanted in the corpus callosum (CC) at PND21, which is the age corresponding to a 2-year-old child from a developmental perspective and until which CP is often not formally diagnosed, followed or not by Botulinum toxin injections in the unaffected forelimb muscles at PND23, 26, 29 and 32 to apply CIMT. Both interventions led to enhanced CC myelination and significant functional recovery (as shown by rearing and gait analysis testing), through the recruitment of endogenous oligodendrocytes. The combinatorial treatment indicated a synergistic effect, as shown by newly recruited oligodendrocytes and functional recovery. This work demonstrates the mechanistic effects of CIMT and NPC transplantation and advocates for their combined therapeutic potential in addressing hemiplegic CP.

Long COVID Brain Fog Treatment: Findings from a Pilot Randomized Controlled Trial of Constraint-Induced Cognitive Therapy.

Long COVID brain fog is often disabling. Yet, no empirically-supported treatments exist. This study's objectives were to evaluate feasibility and efficacy, provisionally, of a new rehabilitation approach, Constraint-Induced Cognitive Therapy (CICT), for post-COVID-19 cognitive sequelae. Sixteen community-residents ≥ 3-months post-COVID-19 infection with mild cognitive impairment and dysfunction in instrumental activities of daily living (IADL) were enrolled. Participants were randomized to Immediate-CICT or treatment-as-usual (TAU) with crossover to CICT. CICT combined behavior change techniques modified from Constraint-Induced Movement Therapy with Speed of Processing Training, a computerized cognitive-training program. CICT was deemed feasible if (a) ≥80% of participants completed treatment, (b) the same found treatment highly satisfying and at most moderately difficult, and (c) <2 study-related, serious adverse-events occurred. The primary outcome was IADL performance in daily life (Canadian Occupational Performance Measure). Employment status and brain fog (Mental Clutter Scale) were also assessed. Fourteen completed Immediate-CICT (n=7) or TAU (n=7); two withdrew from TAU before their second testing session. Completers were [M (SD)]: 10 (7) months post-COVID; 51 (13) years old; 10 females, 4 males; 1 African American, 13 European American. All the feasibility benchmarks were met. Immediate-CICT, relative to TAU, produced very large improvements in IADL performance (M=3.7 points, p<.001, d=2.6) and brain fog (M=-4 points, p<.001, d=-2.9). Four of five non-retired Immediate-CICT participants returned-to-work post-treatment; no TAU participants did, p=.048. CICT has promise for reducing brain fog, improving IADL, and promoting returning-to-work in adults with Long COVID. Findings warrant a large-scale RCT with an active-comparison group.

Using mechanistic knowledge to appraise contemporary approaches to the rehabilitation of upper limb function following stroke.

It is a paradox of neurological rehabilitation that, in an era in which preclinical models have produced significant advances in our mechanistic understanding of neural plasticity, there is inadequate support for many therapies recommended for use in clinical practice. When the goal is to estimate the probability that a specific form of therapy will have a positive clinical effect, the integration of mechanistic knowledge (concerning 'the structure or way of working of the parts in a natural system') may improve the quality of inference. This is illustrated by analysis of three contemporary approaches to the rehabilitation of lateralized dysfunction affecting people living with stroke: constraint-induced movement therapy; mental practice; and mirror therapy. Damage to 'cross-road' regions of the structural (white matter) brain connectome generates deficits that span multiple domains (motor, language, attention and verbal/spatial memory). The structural integrity of these regions determines not only the initial functional status, but also the response to therapy. As structural disconnection constrains the recovery of functional capability, 'disconnectome' modelling provides a basis for personalized prognosis and precision rehabilitation. It is now feasible to refer a lesion delineated using a standard clinical scan to a (dis)connectivity atlas derived from the brains of other stroke survivors. As the individual disconnection pattern thus obtained suggests the functional domains most likely be compromised, a therapeutic regimen can be tailored accordingly. Stroke is a complex disorder that burdens individuals with distinct constellations of brain damage. Mechanistic knowledge is indispensable when seeking to ameliorate the behavioural impairments to which such damage gives rise.

Constraint Induced Movement Therapy Confers only a Transient Behavioral Benefit but Enduring Functional Circuit-Level Changes after Experimental TBI.

Although the behavioral outcome of Constraint-Induced Movement Therapy (CIMT) is well known, and that a combination of CIMT and arm use training potentiates the effect, there has been limited study of the brain circuits involved that respond to therapy. An understanding of CIMT from a brain network level would be useful for guiding the duration of effective therapy, the type of training regime to potentiate the outcome, as well as brain regional targets that might be amenable for direct neuromodulation. Here we investigated the effect of CIMT therapy alone unconfounded by additional rehabilitation training in order to determine the impact of intervention at the circuit level. Adult rats were injured by controlled cortical impact injury and studied before and then after 2wks of CIMT or noCIMT at 1-3wks post-injury using a combination of forelimb behavioral tasks and task-based and resting state functional magnetic resonance imaging at 3 and 7wks post-injury and compared to sham rats. There was no difference in behavior or functional imaging between CIMT and noCIMT after injury before intervention so that data are unlikely to be confounded by differences in injury severity. CIMT produced only a transient reduction in limb deficits compared to noCIMT immediately after the intervention, but no difference thereafter. However, CIMT resulted in a persistent reduction in contralesional limb-evoked activation and a corresponding ipsilesional cortical plasticity compared to noCIMT that endured 4wks after intervention. This was associated with a significant amelioration of intra and inter-hemispheric connectivity present in the noCIMT group at 7wks post-injury.

Constraint-Induced Movement Therapy in Pediatric Stroke: Clinical Landscape &amp; Implementation Barriers

Abstract Date Presented 03/22/24 This study describes the current landscape of constraint-induced movement therapy (CIMT) in the United States, with a focus on identifying barriers to its broader implementation to increase access to this underutilized intervention. Primary Author and Speaker: Sophia Larson Contributing Authors: Hunter Moore, Alyssa Smith, Bhooma Aravamuthan, Sharon Ramey, Catherine Hoyt

Measuring Fidelity of Constraint-Induced Movement Therapy Delivery with Combined Neuromodulation (Transauricular Vagal Nerve Stimulation)

Abstract Date Presented 03/22/24 Assessment of treatment fidelity is essential when complementing effective motor based therapies like CIMT with neuromodulation. This will ensure successful translation to clinical practice and maintain effectiveness of OT interventions. Primary Author and Speaker: Elizabeth Humanitzki Additional Authors and Speakers: Patty Coker-Bolt, Kelly McGloon, Julia Schroeder Brennan Contributing Authors: Annie Cribb, Alyssa Brennan, Philipp Summers, Bashar W. Badran, Mark George, Dorothea Jenkins