Use Of Constraint-induced Therapy Research Articles

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, …

Heart and Soul of a Profession

Journals such as this one are special because they are “owned” by an entire profession, through individual memberships in an association. Each member of the American Physical Therapy Association owns Physical Therapy . As a result, I believe that the Journal is obligated to accomplish many things: to publish original research and other types of content, such as case reports, updates, and perspectives; to disseminate important Association documents; and to help our profession and our patients by raising questions and stimulating dialogue about critical issues. This month we serve the Journal's mission with articles on fall prediction, the efficacy of a videotape-based exercise program for patients with fibromyalgia, quadriceps femoris muscle weakness after total knee arthroplasty, whether similar electrical stimulation protocols can be used on lower-extremity muscles of differing fiber composition, whether a recently proposed form of mobilization causes a physiological effect similar to that of more commonly used forms, and the use of constraint-induced therapy on a 53-year-old woman who had a stroke 15 years earlier. These articles offer a wide view of the physical therapy profession and provide practitioners with information that they can use to be more effective. The benefits and use of new knowledge are discussed often in these Editor's Notes. This month, however, I am reminded of the need to place new knowledge in context. Yes, we need …