Pediatric Constraint-Induced Movement Therapy Research Articles

The effect of constraint-induced movement therapy for children with hemiplegic cerebral palsy in Vietnam

Purpose Pediatric constraint-induced movement therapy (CIMT) is an evidence-based treatment that has a long history of demonstrating efficacy for children with hemiparesis. The purpose of this study is to determine the effectiveness of a culturally responsive CIMT program for children with hemiplegic cerebral palsy (CP) developed for the Vietnam healthcare system. Methods Thirty children with hemiplegic CP (mean age = 2.88 years, age range: 1 to 8 yrs, 60% male) were recruited to a CIMT program (7.5 h/week, 4 weeks) developed for the cultural context of Vietnam. Motor abilities of the affected arm and participation in daily activities were evaluated at 3 time points (one-week prior to CIMT (baseline), one-week before (pre) and after (post) CIMT) using the Quality of Upper Extremity Skill Test (QUEST) and Pediatric Motor Activity Log-Revised (PMAL-R). Individual goals were measured using the Goal Attainment Scale (GAS). Results There were significant increases in the “How often scale” and “How Well” scales of the PMAL-R (0.75 and 0.75, p < 0.00)). Score of Grasp and Dissociated Movement items on the QUEST increased significantly (6.47 and 7.63, p < 0.001). Group GAS T-Scores were 52.19 indicating that children met individual goals. Conclusions A model of CIMT was successfully developed and delivered within the Vietnamese healthcare system. Future studies should explore the optimal model for CIMT in various regions of world where the delivery of rehabilitation services may vary.

Hybrid Telehealth Pediatric Constraint Induced Movement Therapy Compared to In-person Intervention: A Case Series.

Constraint induced movement therapy is an established, evidence-based intervention for children with hemiplegia. This case series describes the feasibility and clinical opportunities of using a hybrid telehealth and onsite model to deliver pediatric constraint induced movement therapy during the COVID-19 pandemic. These cases support that a hybrid model had a similar effect on upper extremity improvement compared to a traditional, in-person model and may be an option when access to in-person care is not available.

Expanding Practice in Trinidad and Tobago: Training Therapists to Implement Pediatric Constraint-Induced Movement Therapy

Expanding Practice in Trinidad and Tobago: Training Therapists to Implement Pediatric Constraint-Induced Movement Therapy

Efficacy of Intensive, Group-Based Intensive Constraint-Induced Movement Therapy (CIMT) in Young Children With Hemiparesis

Abstract Date Presented 04/01/2022 This panel will discuss a research study measuring the effects of intensive, group-based pediatric constraint-induced movement therapy (CIMT) for children ages 2 to 6 with hemiplegia. Results produced many statistically significant improvements in unilateral function, bimanual coordination, and occupational performance. Primary Author and Speaker: Katherine S. Ryan-Bloomer Additional Authors and Speakers: Lily B. Davis, Katelin T. Watkins, Kyra T. Woods, Bethany Tackett

Improved Hand Function in Children with Cerebral Palsy with Repeat Doses of Group Based Hybrid Pediatric Constraint-Induced Movement Therapy

The study’s aim is to analyze the improved hand function and bimanual performance with unilateral cerebral palsy (CP) from repeat doses of an augmented, group-based pediatric constraint-induced movement therapy (pCIMT) camp. Fifteen children with unilateral CP (ages 5–15 years, 9 male, 6 female, Manual Abilities Classification System (MACS) I = 3, MACS II = 11, and MACS III = 1) participated in two sessions of an annual pCIMT camp. Participants attended 10 days of camp where they received group-based training wearing a constraint for a total of 50 h, received bilateral, occupation-based activities for 10 h (60 h total) including 30 min each day on the Hocoma Armeo®Spring. The Assisting Hand Assessment (AHA) was administered pre-intervention and post-intervention. Our results discovered a mean interval dose 1 and 2 was 511 days. Dose 1 mean AHA score at baseline was 55.93 ± 12.78 and 63.07 ± 12.85 at post. Dose 2 mean AHA score as 58.13 ± 14.83 and post 66.53 ± 12.82. In conclusion, there was an overall significant bimanual functional improvement based on AHA scores that indicate, regardless of which camp session, scores improved from pre-intervention to post-intervention. There was a generalized upward trend in improved hand function of a group-based pCIMT, and diminished effects between doses were reversed with repeat doses.

Exploring the Intensity, Frequency, and Duration of Pediatric Constraint Induced Movement Therapy Published Research: A Content Analysis.

Constraint Induced Movement Therapy (CIMT) utilizes a behavioral approach to neurorehabilitation involving constraint of an unaffected upper extremity which forces the use of the affected extremity. There is substantial evidence supporting the effectiveness of CIMT among both children and adults. The purpose of this study was to explore the frequency, intensity, and duration parameters across the published clinical outcomes related to pediatric CIMT (pCIMT) among children and youth populations. A content analysis approach was used to search the following databases Google Scholar, OT seeker, American Occupational Therapy Association special interest section, Medline, EbscoHost, and Cinhal. A total of 141 studies were identified via the initial search, with 51 studies meeting inclusion criteria. The findings revealed that 100% of the studies included restraint of the non-affected upper extremity, 73% incorporated repetitive task-oriented training, but less than half prescribed home practice strategies. Further, only 34% of the studies reviewed included all three components of CIMT. Outpatient hospital clinics and home-based settings were the most utilized settings for research studies. The mean minutes per session was M = 205.53, SD = 164.99. As part of the plan of care, the duration and frequency of therapy both had similar means (~M = 3.60) and standard deviations (~SD = 1.65). There was a significant variance of hours during (SD = 139.54) and outside of therapy (SD = 130.06). The results of this study, together with other emerging evidence, can assist practitioners in prescribing dosages dependent on the setting, the pediatric client, and their current functional status.

Assessment of Treatment Fidelity Within Applications of Pediatric Constraint-Induced Movement Therapy

Abstract Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. This proposal will present and review data from a fidelity-of-intervention tool currently used to evaluate the fidelity of implementation in pediatric constraint-induced movement therapy (pCIMT). Measuring treatment fidelity in OT environments will allow therapists to translate core components of therapies that have been scientifically validated as efficacious. This is critical for pCIMT as it is widely used in the treatment of children with hemiparesis across clinical settings Primary Author and Speaker: Megan D. Price Contributing Authors: Stephanie DeLuca, Sharon Landesman Ramey, Amy Darragh, and Rich Stevenson

Improved Hand Function in Children With Cerebral Palsy With Repeat Doses of Augmented Pediatric Constraint-Induced Movement Therapy

Abstract Date Presented 04/13/21 Children with unilateral cerebral palsy participating in repeat doses of pediatric constraint-induced movement therapy camp augmented with the Hocoma Armeo®Spring demonstrated significant improvements in hand function and bimanual performance for both doses and showed a generalized upward trend in hand function over time. Primary Author and Speaker: Heather Roberts Additional Authors and Speakers: Sara P. Johnston, David Plutschack

Use of a Caregiver Coaching Model for Implementation of Intensive Motor Training for Hemiplegic Cerebral Palsy: A Case Study

Background: There is extensive literature to support the efficacy of both pediatric constraint-induced movement therapy (pCIMT) and hand-arm bimanual intensive therapy (HABIT) for children with hemiplegic cerebral palsy. In addition, there is increasing evidence to support the training of caregivers (parents and other care providers) to carry out therapy interventions in the home. The Family Activity Adaptation Model (FAAM) presents guidelines for parent and caregiver coaching for intensive therapies used in occupational therapy practice.

Constraint Induced Movement Therapy Camp for Children with Hemiplegic Cerebral Palsy Augmented by Use of an Exoskeleton to Play Games in Virtual Reality

Aim To determine the acceptability and effects of a pediatric constraint induced movement therapy (P-CIMT) camp for children with hemiplegic cerebral palsy (hCP) augmented by use of an exoskeleton to play games in virtual reality (VR). Method 31 children with hCP attended a P-CIMT camp 6 hours per day for 10 days over 2 successive weeks (60 hours) that included 30 minutes of unilateral training with the Hocoma Armeo®Spring Pediatric that combines the assistance of an exoskeleton and VR games. The primary outcome measure was the Assisting Hand Assessment (AHA); secondary outcome measures were the Melbourne Assessment of Uni-lateral Hand Function (MUUL), and the Canadian Occupational Performance Measure (COPM). Assessments were completed at pre-intervention, post-intervention, and 6 months following intervention. Results Participants demonstrated clinically and statistically significant improvement in bimanual performance (AHA) (p < .001) and COPM Performance (p < .001) and Satisfaction with performance (p < .001). Improvement in unilateral performance (MUUL) was statistically (p < .001) but not clinically significant. Conclusions A P-CIMT camp augmented by the Hocoma Armeo®Spring Pediatric was feasible and accepted by participants. Bimanual hand function and occupational performance improved immediately following intervention, and the treatment effects persisted 6 months following intervention.

Improving Quality of Life for Children With Cerebral Palsy in Vietnam: Implementation of Intensive Models of Rehabilitation

Abstract Date Presented 03/27/20 The aims were to determine if two models of pediatric constraint-induced movement therapy (CIMT) could be delivered with acceptable fidelity in Vietnam and if CIMT could improve the motor skills of Vietnamese children with hemiplegic cerebral palsy. Therapists successfully partnered with families to implement CIMT and children in both low- and high-dose CIMT groups showed improvements in performance of everyday activities. This study provides insight into how pediatric CIMT can be provided in areas where resources may be limited (rural areas). Primary Author and Speaker: Caitlin Weatherhead Additional Authors and Speakers: Rebekah Wade, Chandler Nash, Sarahjane Zablow, Patty Coker-Bolt Contributing Authors: Stephanie DeLuca, Johan Baudewigns, Miranda Gerrard, Megan Price

Measuring the Efficacy of Multiple Dosages of Pediatric Constraint-Induced Movement Therapy (pCIMT) in Young Children With Hemiparesis

Abstract Date Presented 04/05/19 This poster will discuss a research study measuring the effects of multiple dosages of a pediatric constraint induced movement therapy (pCIMT) summer camp program for children two to six years of age. Children attended two summer CIMT programs two years in a row and were assessed using the same outcomes. Methodology and results will be shared. Primary Author and Speaker: Katherine Ryan-Bloomer Additional Authors and Speakers: Michelle Deves, Haley Padgett, Nichelle Meyer, Jenna Richardson, Jordan Shy, Bethany Tackett

Using TheraBracelet as an Adjunct to Pediatric Constraint-Induced Movement Therapy in Cerebral Palsy

Abstract Date Presented 04/05/19 Primary Author and Speaker: Turki Aljuhani Additional Authors and Speakers: Amanda Vatinno Contributing Authors: Alison Fluharty, Catilyn Taylor, Eli Schuster, V. Ramakrishnan, Patty Coker-Bolt, Na Jin Seo

Reporting collateral effects of pediatric constraint induced movement therapy: Parent observed speech and language changes

Abstract In recent years the body of evidence for intensive bouts of therapeutic intervention in single disciplines has significantly grown. Implementation of these protocols has gained popularity clinically. Understanding collateral aspects of these intensive occupational and physical therapy sessions is of interest to families and clinicians of various disciplines. This project establishes a uniform documentation method for family comments recorded during home programs using the International Classification of Functioning, Disability and Health-Children and Youth (World Health Organization, 2007) and seeks to identify trends in these anecdotal responses by age group.

Feasibility of application of constraint-induced movement therapy in a child with hemiplegic cerebral palsy: A single-case study

Children suffering from hemiplegic cerebral palsy (CP) develop developmental disregard (DD). In addition, they fail to comprehend the consequences of nonuse. The utility of affected upper limb is jeopardized. Current evidence supports the use of constraint-induced movement therapy (CIMT) for upper limb function in individuals with hemiplegia. This single-case study attempts to identify feasibility of application of pediatric CIMT on a child with hemiplegic CP. The aim of this study is to identify the benefits and feasibility of application of CIMT for improving quality of the upper limb movement in a child with hemiplegic CP. A 2½-year-old girl with hemiplegic CP visited the outpatient department (OPD) with the problem of lack of use of the right upper limb for activities and play along with the poorer quality of the upper limb movement. Disregard index was calculated to identify the presence of DD. CIMT was chosen as the child had above minimal ability to open fingers and extend the wrist. A 2-week intervention was designed based on the goal-oriented, ability-specific, child-specific practice of functional tasks. A rigid tape was used to provide constraint. The child was motivated to play with the affected hand for 2 h in the OPD and 2 h at home. Tasks of incremental difficulty were utilized as shaping method. The improvement in the quality of movement was measured using quality of upper extremity skilled test (QUEST) and Assisting Hand Assessment (AHA). The score on QUEST improved from 66.35 to 72.1, AHA improved from 66 to 73, and the disregard index score improved from 42.75 to 26.3 in 2 weeks. The treatment was adjusted to accommodate the behavior of the child.

Quantifying Real-World Activity and Upper-Limb Use in Children with Cerebral Palsy Using Accelerometers

Abstract Date Presented 4/8/2016 This study used accelerometers to quantify the real-world activity and affected upper-limb use of children with cerebral palsy who participated in constraint-induced movement therapy (CIMT). Use of accelerometers as an outcome measure for pediatric CIMT are promising but will need confirmation in a larger study with a higher therapy dosage. Primary Author and Speaker: Patty Coker-Bolt Additional Authors and Speakers: Jackie Connelly, Na Jin Seo, Reagin Hoover, Ryan Downey, Daniel Shelton

Modified Constraint-Induced Movement Therapy as a Home-Based Intervention for Children With Cerebral Palsy.

This study was designed to investigate the benefit to upper limb function of a home-based version of pediatric constraint-induced movement therapy, which was delivered across 2 months. Nine children (mean age: 6 years, 9 months) with hemiplegic cerebral palsy participated in this A1-B-C-A2 design, where A1 and A2 were nonintervention phases. In phases B and C, participants wore a splint on the unaffected hand. In phase C, motivating feedback through a computer game was added. The Melbourne Assessment of Unilateral Upper Limb Function and the Quality of Upper Extremity Skills Test scores were significantly higher at the end of phases B (P = .037 and P = .006, respectively) and C (P = .001 and P = .001, respectively). Melbourne scores remained higher at the end of phase A2 (P = .001). A nonintensive form of home-based constraint-induced movement therapy was found to be effective. Improvements were larger after the second month of intervention.

Occupational Therapists' Opinions of Two Pediatric Constraint-Induced Movement Therapy Protocols.

We sought to determine occupational therapists' opinions of two pediatric constraint-induced movement therapy (pCIMT) protocols. A total of 272 therapists in pediatric rehabilitation clinics completed an electronic survey to determine their opinions of two published pCIMT protocols. In Protocol A, restraint is worn 24 hr/day on the nonparetic upper extremity (UE), and in-clinic, therapist-supervised practice sessions occur 7 days/wk for 6 hr/day over 3 wk. In Protocol B, restraint is worn 2 hr/day on the nonparetic UE, and in-clinic, therapist-supervised practice sessions occur 1 day/wk for 2 hr/day over 8 wk. The majority of participants reported moderate to high concerns about every facet of Protocol A. Conversely, >50% of participants reported low or no concerns about five of seven facets of Protocol B. This study adds to a growing body of evidence suggesting that therapists strongly prefer low-duration pCIMT protocols.

Pediatric Constraint-Induced Movement Therapy: The Efficacy of Multiple Treatment Sessions

Pediatric Constraint-Induced Movement Therapy: The Efficacy of Multiple Treatment Sessions

A Multi-Center Randomized Controlled Trial of Pediatric Constraint-Induced (P-Cimt) Movement Therapy

A Multi-Center Randomized Controlled Trial of Pediatric Constraint-Induced (P-Cimt) Movement Therapy