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Constraint-Induced Movement Therapy

Constraint-Induced Movement Therapy. In the treatment of children with hemiplegic CP. Why CIMT. Reduced UE functioning Unilateral motor impairment Sensory abnormalities Weak grasp Loss of fine-sequencing and of movement Loss of fine motor skills Associated and mirror movements

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Constraint-Induced Movement Therapy

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  1. Constraint-Induced Movement Therapy In the treatment of children with hemiplegic CP

  2. Why CIMT • Reduced UE functioning • Unilateral motor impairment • Sensory abnormalities • Weak grasp • Loss of fine-sequencing and of movement • Loss of fine motor skills • Associated and mirror movements • Retention of grasp reflex and spasticity (Brown 1987, Eliasson, 1995, Eliasson 2000)

  3. Functional Impairment • Learned non-use • Use of non-affected hand even when non dominant • Further impairment h muscle tone Poor motor control i ROM, strength, and delayed skeletal maturation (Roberts 1994, Scrutton, 2004)

  4. Review • 1966-2006 • 214 references; • 26 potentially relevant articles; • 23 excluded • 3 trial articles included • 1 RCT; CIMT; 18 children • 1 CCT; mCIMT; 41 children • 1 RCT; Forced method; 31 children

  5. Types of Treatment • CIMT (bivalve cast 21 days; 6 hours/day shaping) vs traditional services groups • mCIMT (mitt for 2 hours/day; 60 days; 2 hours/day motor control tx) vs traditional tx services • Forced use protocol (short arm cast for 6 weeks no other tx) vs traditional treatment

  6. Review • Children 7months to 8 years • Different outcome measures • Unable to blind • Did not pool data

  7. Review • Small sample size so possible not to find statistical differences • Indications of clinical significance • No support for super intense protocol • Argument between in home and in clinic treatment needs to be further assessed • Multiple factors could be related to + CIMT outcome

  8. Implication • CIMT should be considered experimental • Need more research • Level of intensity • Valid & reliable outcome measures • Least invasive, most family friendly • Cost effective • At what age is it most appropriate

  9. Impact of Treatment/My Take on it • Shown to have clinical relevance • “sexy treatment” • Restoration vs adaptation • Very worthwhile to explore

  10. Group Discussion

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