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Constraint Induced Movement Therapy in Paediatric Cerebral Palsy: A Case SeriesBlaithin Hadjisophocleous, CIMT Therapist

BACKGROUND

PARTICIPANTS

• 7 children – 3 males and 4 females aged 19 months to 11 years

• Diagnosis of cerebral palsy resulting in hemiplegia

• Suitability criteria:

• > 18 months old at the time of treatment

• Must have the ability to tolerate treatment programme

• > 10 degrees of active finger and wrist extension

• Parents / carers who are able to actively participate in programme and post-treatment

INTERVENTION• 3 weeks, 5 days per week, 3 hours per day

• One-to-one therapy

• A non-removable soft cast was used to constrain the less affected arm and was kept on throughout the duration of the programme

• Repetitive play-based task-specific activities, involving challenging yet achievable goals that were progressively made harder

• Shaping tasks:

• selecting tasks that were tailored to address the motor deficits of the individual patient

• verbal feedback and verbal reward for small improvements in task performance

• helping the patient to carry out parts of a movement sequence if unable to do independently at first

• systematically increasing the difficulty of the task

OUTCOME MEASURECONCLUSIONS

• According to the results of this study, a 3-week intensive CIMT programme was beneficial in improving function in the hemiplegic upper limb in children.

• Further research:

• Long term effects and cost effectiveness of CIMT

• Effects of CIMT on various age groups

• Cast vs mitt as method of constraint

RESULTS

• All children apart from one improved in the domain of amount of movement.

• Four children made clinically significant improvements, and two of them improved but the results were not clinically or statistically significant.

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Amount of Movement

Before After

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Quality of Movement

Before After

• All children improved in terms of quality of movement.

• Four of the seven children made a clinically significant improvement.

• Paediatric Motor Activity Log (PMAL)

• A patient-evaluated measure

• 22 questions on unilateral and bilateral function of the affected upper limb. Assesses quality of movement and amount of use in their natural environment.

• Each item scored 0-5

• Assessment completed by parents at the start of the programme and 2 weeks after the end of the programme.

• Children with hemiplegic cerebral palsy grow and develop by using compensatory strategies to avoid using their weaker side.

• Behaviourally: developmental disregard / learned non-use.

• Physiologically: use-dependent cortical reorganization and this process can be reversed.