Pediatric Constraint-Induced Therapy Research Articles

Pediatric Constraint-Induced Therapy: Checking under the Hood Before Jumping on the Bandwagon

Pediatric Constraint-Induced Therapy: Checking under the Hood Before Jumping on the Bandwagon

Commercial Exergaming in Home-Based Pediatric Constraint-Induced Therapy: A Randomized Trial.

Constraint-induced therapy (CIT) is highly effective yet not accessible to many families. Integrating commercial exergaming in home-based CIT may support the availability and attainability of the intervention. The study compared the effects of supplementary use of Nintendo Wii in home-based CIT with dose-equivalent conventional CIT. Eighteen children with cerebral palsy were randomly assigned to 8 weeks of CIT (CIT) or 4 weeks of CIT, followed by 4 weeks of Wii-augmented CIT (CIT-Wii). Outcome measures included the Bruininks-Oseretsky Test of Motor Proficiency (Manual Dexterity), the ABILHAND-Kids, the WeeFIM (Self-Care), the Test of Playfulness, the Engagement Questionnaire, and the Parenting Stress Index-Short Form. Both groups significantly improved motor outcomes and playfulness. The CIT group demonstrated greater improvement in self-care skills, whereas parental stress decreased only in the CIT-Wii group. CIT-Wii yields no significant difference in treatment effects from conventional CIT and may provide psychosocial benefits.

Logistic regression analyses for predicting clinically important differences in motor capacity, motor performance, and functional independence after constraint-induced therapy in children with cerebral palsy

Given the growing evidence for the effects of constraint-induced therapy (CIT) in children with cerebral palsy (CP), there is a need for investigating the characteristics of potential participants who may benefit most from this intervention. This study aimed to establish predictive models for the effects of pediatric CIT on motor and functional outcomes. Therapists administered CIT to 49 children (aged 3-11 years) with CP. Sessions were 1-3.5h a day, twice a week, for 3-4 weeks. Parents were asked to document the number of restraint hours outside of the therapy sessions. Domains of treatment outcomes included motor capacity (measured by the Peabody Developmental Motor Scales II), motor performance (measured by the Pediatric Motor Activity Log), and functional independence (measured by the Pediatric Functional Independence Measure). Potential predictors included age, affected side, compliance (measured by time of restraint), and the initial level of motor impairment severity. Tests were administered before, immediately after, and 3 months after the intervention. Logistic regression analyses showed that total amount of restraint time was the only significant predictor for improved motor capacity immediately after CIT. Younger children who restrained the less affected arm for a longer time had a greater chance to achieve clinically significant improvements in motor performance. For outcomes of functional independence in daily life, younger age was associated with clinically meaningful improvement in the self-care domain. Baseline motor abilities were significantly predictive of better improvement in mobility and cognition. Significant predictors varied according to the aspects of motor outcomes after 3 months of follow-up. The potential predictors identified in this study allow clinicians to target those children who may benefit most from CIT.

The behavior-analytic origins of constraint-induced movement therapy: An example of behavioral neurorehabilitation

Constraint-induced (CI) therapy is a term given to a family of efficacious neurorehabilitation treatments including to date: upper extremity CI movement therapy, lower extremity CI movement therapy, pediatric CI therapy, and CI aphasia therapy. The purpose of this article is to outline the behavior analysis origins of CI therapy and the ways in which its procedures incorporate behavior analysis methods and principles. The intervention is founded on the concept of learned nonuse, a mechanism now empirically demonstrated to exist, which occurs after many different types of damage to the central nervous system (CNS). It results from the dramatic alteration of the contingencies of reinforcement that results from substantial CNS damage and leads to a greater deficit than is warranted by the actual damage sustained. CI therapy produces a countervailing alteration in the contingencies of reinforcement. The intervention has been used successfully to substantially improve motor deficits after stroke, traumatic brain injury, spinal cord injury, multiple sclerosis, with cerebral palsy in a pediatric population, and for language impairment in poststroke aphasia. The protocol of CI therapy consists primarily of standard behavior-analytic methods. It produces a marked plastic brain change that is correlated with its therapeutic effect, and therefore provides an example of the way in which behavior change can contribute to a profound remodeling of the brain. CI therapy may be viewed as an example of behavioral neurorehabilitation.

Intensive Pediatric Constraint-Induced Therapy for Children With Cerebral Palsy: Randomized, Controlled, Crossover Trial

A randomized crossover trial of a new form of pediatric rehabilitation was conducted with 18 children with hemiparesis. Half were randomly assigned to receive pediatric constraint-induced therapy involving constraint of the functional upper extremity and intensive therapy with the hemiparetic upper extremity. Controls received conventional physical and occupational therapy and then were crossed over to receive pediatric constraint-induced therapy. Pediatric constraint-induced therapy produced significantly greater gains than conventional rehabilitation services.

Development of hand–arm bimanual intensive training (HABIT) for improving bimanual coordination in children with hemiplegic cerebral palsy

Constraint-induced (CI) movement therapy is a physical intervention that has been receiving increasing attention in pediatric rehabilitation. So far, the evidence suggests that practice associated with CI therapy may improve impaired unimanual hand function in some children with hemiplegic cerebral palsy (CP). However, CI therapy has several important limitations. Most importantly, children with hemiplegia have impairments in bimanual coordination beyond their unilateral impairments. Thus, an intervention approach to increase functional independence during activities of daily living by using both hands in cooperation is needed. Here we briefly review the etiology of hemiplegic CP, describe studies of pediatric CI therapy efficacy in relation to the etiology, discuss the conceptual and practical limitations of CI therapy for this population, and describe bimanual coordination impairments in children with hemiplegia. Finally, we introduce a new intervention for children with hemiplegia, hand-arm bimanual intensive training (HABIT), to address the limitations of CI therapy and to improve bimanual coordination. HABIT retains the two major elements of pediatric CI therapy (intensive structured practice and child-friendliness). The proposed methodology demonstrates that extensive targeted practice can be provided in a child-friendly manner without using a physical restraint, although the efficacy of such an approach remains to be determined.

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?

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, …

Pediatric Constraint-Induced Movement Therapy for a Young Child With Cerebral Palsy: Two Episodes of Care

This case report describes the use of "Pediatric Constraint-Induced Therapy (Pediatric CI Therapy)" given on 2 separate occasions for a young child with quadriparetic cerebral palsy. The child was 15 months of age at the beginning of the first episode of care. She had previously received weekly physical therapy and occupational therapy for 11 months, but she had no functional use of her right upper extremity (UE), independently or in an assistive manner. She scored from 5 to 7 months below her chronological age on developmental assessments in gross motor, fine motor, and self-help skills. Pediatric CI Therapy involved placement of a full-arm, bivalved cast on the child's less affected UE while providing 3 weeks of intensive intervention (6 hours a day) for the child's more affected UE (intervention 1). Therapy included activities that were goal oriented but broken down into progressively more challenging step-by-step tasks. Pediatric CI Therapy was administered again 5 months later to promote UE skills and independence (intervention 2). The child developed new behaviors throughout both interventions. During intervention 1, the child developed independent reach, grasp, release, weight bearing (positioned prone on elbows) of both UEs, gestures, self-feeding, sitting, and increased interactive play using both UEs. During intervention 2, she had increased independence and improved quality of UE movement, as supported by blinded clinical evaluations and parent ratings.