Constraint-induced movement therapy for hemiplegic children with acquired brain injuries

Abstract

Objective: To evaluate the feasibility and efficacy of constraint-induced movement therapy (CIMT) for impaired upper extremity (UE) function in children with acquired brain injury (ABI).

Design: Multiple case studies.

Setting: Inpatient pediatric rehabilitation.

Participants: Seven consecutive ABI rehabilitation admissions with hemiparesis were recruited without regard to injury etiology, age, or cognitive capacities.

Main outcome measure: The actual amount of use test (AAUT) was used to evaluate change in UE function. AAUT amount of use (AOU) and quality of movement (QOM) scales were obtained at baseline and follow-up.

Results: AOU and QOM item improvements were significant, as were changes in activities of daily living. The effect sizes for these changes were large.

Conclusions: Stringent CIMT training, previously only implemented with adults, can be used effectively with children when everyday elements of a child's life are integrated into adult protocols. The use of child-friendly UE shaping exercises, "pushed into" activities by professional therapists as well as trained teachers, paraprofessionals, and parents, was supported. Effects of impairment, injury, and behavior on outcomes are discussed. Larger controlled studies with additional outcome measures are indicated.