Children’s Upper Limb Function and Constraint Induced Movement Therapy

Is there a connection between Constraint-Induced Movement Therapy (CIMT) and the resulting improved upper limb function for children with hemiplegic Cerebral Palsy? A study by Sheri Montgomery, OTR/L, FAOTA University of Utah OTD dated October 2012 discusses this theory. Children that have upper limb hemiplegia often have decreased ability to participate efficiently and effectively in tasks and occupations that require use of both hands. This may include fastening buttons while getting dressed, climbing the monkey bars or school activities such as opening a gym locker or completing a standardized academic assessment such as during play using a keyboard. Amongst the traditional strategies used by OTs for the treatment of upper limb hemiplegia are: fine motor skill reinforcement, strengthening of the affected limb, Electrical Muscular Stimulation (EMS) and Neurodevelopmental Treatment (NDT) techniques. In addition they have also implemented constraint-induced movement therapy programs as a type of intervention. Originally used only with adults this treatment has been used increasingly with children since 1990. CIMT was originally used in conjunction with Botox but the research wants to determine if it can be used alone. The question is can CIMT increase upper limb skills of children with hemiplegic CP to allow for age appropriate actions such as: self care and playing with other children? A review of nineteen studies was made that showed that: • Statistically and clinically significant improvement was noted in self-care and bilateral upper extremity use after two-weeks treatment with constraint-induced movement therapy for children with hemiplegic cerebral palsy. • The greatest improvement was when CIMT was paired with goal directed therapeutic intervention programs. Intensity of CIMT did not have any significant influence on the outcomes or improved motor skills. Bottom line evidence suggests that constraint-induced movement therapy results in an increased use of the affected limb, especially when matched with therapeutic interventions intended to increase strength, control and functional use. It made no difference if children wore the restraint for 3.5 hours a day or 10 hours. The greatest improvement in functional skills was observed when Constraint Induced Movement Therapy was paired with goal specific interventions. Today adult and child patients with upper limb hemiplegia can take advantage of one of the most effective physical therapy products for use in CIMT. The HANDTUTOR has been devised to provide intensive repetitive functional task exercises. The HANDTUTOR system allows for the customization of exercise tasks to a level that allows patients with severe movement dysfunction to start intensive exercise practice with their impaired hand. The HANDTUTOR improves patient functional upper extremity movement ability in severe and moderate movement dysfunction. The HANDTUTOR intensively trains simple movement parameters using isolated exercise practice. The tasks can be set according to the individual patient’s limits of movement ability and the difficulty of the tasks can be shaped. The feedback gives the patient information on his performance of the tasks and instructions on how to improve his movement. The HANDTUTOR and its sisters (ARMTUTOR, LEGTUTOR, 3DTUTOR) have been used successfully for the treatment of Parkinson’s disease, CP, MS, brain and spinal cord injury, stroke and other upper and lower limb disabilities. Fully certified by the FDA and CE the TUTOR system is available to be used at the patient’s home through the use of telerehabilitation. See WWW.MEDITOUCH.CO.IL for further information.