Document Type

Presentation

Publication Date

8-20-2013

Comments

Handout at bottom of page.

Abstract

Children with cerebral palsy (CP) have various functional impairments impacting participation in meaningful occupations. While Constraint-Induced Movement Therapy (CIMT) is a widely used intervention for adult populations, a modified version of this technique is a relatively new practice in pediatrics (Charles et al., 2006). Occupational therapy intervention, such as CIMT, can support functional goal attainment to enhance participation and quality of life (Boyd et al., 2010). The purpose of this presentation is to synthesize results of a comprehensive evidence-based review and identify treatment characteristics that impact efficacious use of mCIMT on children with hemiplegic CP. Practitioners will learn about best practice strategies according to current literature.

After formulation of a clinical research question, a systematic search of 3 databases was conducted, yielding 15 articles. A rigorous screening process was used with specific inclusion and exclusion criteria. These articles were critiqued to identify the effectiveness of mCIMT. Using Law and MacDermid’s (2008) Appendix M, each article was reviewed by a primary rater with input from a secondary rater. Findings were synthesized and will be discussed in this presentation.

The literature review indicated overall positive results for the use of mCIMT with pediatric CP populations. The majority of studies have found statistically significant results, however, there are mixed conclusions regarding clinical effect. A variety of protocol durations and types of constraints have been investigated, and demonstrate that a minimum of 1-2 hours of constraint wear time for 10-14 consecutive days may be effective in a clinic or home environment. Evidence suggests that the most effective mCIMT protocol involves a child-friendly approach using functional and age-appropriate tasks. Both preparatory and occupation-based activities were assessed utilizing a variety of standardized outcome measures.

This presentation impacts clinical practice by providing evidence about the most effective intervention characteristics for implementing mCIMT as a useful and feasible treatment approach. Overall, children who received mCIMT by a trained interventionist improved functionally regardless of the protocol. Findings suggest less restrictive methods may be comparable to more intensive mCIMT interventions. Therefore, interventionists can tailor a specific mCIMT approach to meet the unique needs of each child.

References:

Boyd, R., Sakzewski, L., Ziviani, J., Abbott, D. F., Badawy, R., Gilmore, R., . . . Jackson, G. D. (2010). INCITE: A randomised trial comparing constraint induced movement therapy and bimanual training in children with congenital hemiplegia. BMC Neurology, 10, 1-15. doi:10.1186/1471-2377-10-4

Charles, J. R., Wolf, S. L., Schneider, J. A., & Gordon, A. M. (2006). Efficacy of a child-friendly form of constraint-induced movement therapy in hemiplegic cerebral palsy: A randomized control trial. Developmental Medicine and Child Neurology, 48(8), 635-642. doi:10.1017/S0012162206001356

Law, M. & MacDermid, J. (2008). Appendix M: Effectiveness Study Quality Checklist. In Evidence-based rehabilitation: A guide to practice (413-423). Thorofare, NJ: Slack, Inc.

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