EFFICACY OF CONSTRAINT-INDUCED MOVEMENT THERAPY INTERVENTION FOR CHILDREN WITH CEREBRAL PALSYAndria VetschMentor: Dr. Jane Case-SmithThe Ohio State University, Occupational Therapy Division and University of Wisconsin-River Falls

Introduction

Cerebral Palsy(CP)Spastic Hemiplegic CPConstraint-Induced Movement

Therapy(CIMT)Features of CIMT

Constraint of the non-affected limb Forced use of the involved upper extremity Intensive treatment Education of parents

4,5

Past Research

Improved hand-movement efficiency Hands to midline forearm supination and pronation transferring a cube between hands ulnar/palmer grasping with the hands

Investigated the protocol (length, frequency of treatment, populations participating)

Lack of research on fidelity of treatment

1,3,5

2

Purpose

1) Assess the consistency in which therapists administer CIMT in a pediatric hospital outpatient setting.

2) Assess inter-rater reliability of the fidelity measure used to score these consistencies.

3) Evaluate the effects of CIMT on a cohort of children with hemiparetic CP

Methods

Mean age: 3 years

6 females, 4 males

Affected limbs: 6 right, 4 leftPre-Post assessment scores were collected at Nationwide

Children’s Hospital (NCH)

Fidelity measure participants

4 children

Age range: 21months-10years

Mean age: 5 years

3 females, 1 male

Affected limb: 4 right

Video recordings were taken throughout treatment session

and scored by three raters

Mean Score for Pre-Post Test

Mea

n sc

ores

Mean Fidelity RatingRater Mean rating

for TherapistMean rating

for child

1 2.43 2.002 2.07 2.253 2.14 1.69

Conclusion

Pre-Post test scores improved

Consistency can lead to improved efficacy of therapy

Promote the development of new skills and help to generalize skills in a variety of settings

Developing a fidelity measure for CIMT and tracking child outcomes

Further Research

Continue to assess the administration of CIMT

Continue to research the effects of CIMT

Questions?

Thanks to SROP at Ohio State, Dr. Jane Case-Smith, and the University of Wisconsin River-Falls McNair Program for the opportunity to participate in this unique research project.

References

1. Case-Smith, J., and O’Brien,JC. Occupational Therapy for Children. 6th ed. Maryland Heights, MO: Mosby/Elsevier, (2010) Print.

2. DeLuca, Stephanie C., Karen Echols, Charles R. Law, and Sharon L. Ramey. "Intensive Pediatric Constraint-Induced Therapy for Children With Cerebral Palsy: Randomized, Controlled, Crossover Trial." Journal of Child Neurology 21.11 (2006): 931-38. Print.

3. Deluca,SC,Echols,K,Ramey,SL, Taub,E. Pediatric constraint-induced movement therapy for a young child: tow episodes of care. Phy Ther. (2003): 1003-1013Print.

4. Gordon,Andrew M., Charles,Jeanne, Wolf, Steven L. "Methods of Constriant-Induced Therapy for Children with Hemiplegic Cerebral Palsy: Development of a Child-Friendly Intervention for Improving Upper-Extremity Function." Phys. Med. Rehabilitaion 86(2005): 837-44. Print.

5. Taub, Edward, Sharon Landesman Ramey, Stephanie DeLuca, and Karen Echols. "Efficacy

of Constraint-Induced Movement Therapy for Children with Cerebral Palsy with

Asymmetric Motor Impairment." Pediatrics 113.2 (2004): 305-12. Print.