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

1. Efficacy of Constraint-Induced Movement Therapy Intervention for Children with Cerebral Palsy Andria Vetsch, Dr. Jane Case-Smith University of Wisconsin-River Falls The Ohio State University, College of Medicine, Occupational Therapy Division Results Background Conclusion • Consistency throughout treatment will lead to • improved efficacy of therapy. • Extended practice and encouraging transfer • of skill helps to generalize skills in a variety • of settings. Ratings for these two items • should be increased. • Developing a fidelity measure for CIMT and • tracking child outcomes will lead to improved • practices and optimal effects for children with • cerebral palsy. • Cerebral palsy (CP) is a chronic condition • that affects body movements and muscle • coordination. • Spastic Hemiplegic is a type of CP that • affects the function of one side of the body, • typically the arm. • Constraint-induced movement therapy • (CIMT) is emerging as a treatment approach • for children with hemiplegic cerebral palsy. • CIMT is used to reduce impairment and • improve functional use of the affected upper • limb. • Features of CIMT • Forced use of the involved upper extremity • Constraint of the non-affected arm • Intensive treatment (occupational therapy) • Education of parents The tables present the percentage for the therapists’ consistency in implementing a theory-based treatment protocol. Mean scores for Pre-Post test Purpose • 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 • Evaluate the effects of CIMT on a cohort of • children with hemiparetic CP References DeLuca SC, Echols K, Law CR, Ramey SL. Intensive pediatric constraint-induced therapy for children with cerebral palsy. J Child Neuro. 2006; 21: 931-938. Taub E, Ramsey SL, DeLuca SC, Echols K. Efficacy of constraint-induced movement therapy for children with cerebral palsy with asymmetric motor impairment. Pediatrics 2004;113:305-312. The graph represents the pre-post test scores of six females and four males that participated in the CIMT program at Nationwide Children’s Hospital. Four had left affected limbs and six had right affected limbs (mean age: 3 years). Methods Discussion • 20 minutes video recordings were taken throughout the intervention weeks which were later scored using the fidelity measure. • Three raters scored four different CIMT sessions and each video contained different children and therapists. • Pre-Post test data was collected from participants of CIMT at Nationwide Children’s Hospital (NCH). 1) The results show that the therapist were being 100% consistent in 5 activities. However, they rarely performed other actions (e.g. encouraging extended practice of targeted movement , encouraged transfer of skill to a variety of tasks/setting). 2) Inter-rater reliability was fair to excellent; correlations ranged from r= 0.50 to 0.95. The reliability for the fidelity items measuring therapist consistency was higher than reliability for the items rating child participation. 3) The CIMT participants made significant improvements in self-care, mobility and overall functional use of their affected limbs. Acknowledgments I would like to thank SROP at Ohio State and The University of Wisconsin-River Falls McNair Scholars Program for giving me the opportunity to experience undergraduate research. In addition, I would also like to thank Dr. Jane Case-Smith and Dr. Alison Lane for their guidance and support throughout this project.