Presented at the International Conference of Neurological Therapy: "Putting Evidence into Practice" - London, 2016 (ACPIN & INPA)

1. Constraint Induced Movement Therapy in Paediatric Cerebral
Palsy: A Case Series
Blaithin Hadjisophocleous, CIMT Therapist
BACKGROUND
PARTICIPANTS
• 7 children – 3 males and 4 females aged 19 months to 11
years
• Diagnosis of cerebral palsy resulting in hemiplegia
• Suitability criteria:
• > 18 months old at the time of treatment
• Must have the ability to tolerate treatment programme
• > 10 degrees of active finger and wrist extension
• Parents / carers who are able to actively participate in
programme and post-treatment
INTERVENTION
• 3 weeks, 5 days per week, 3 hours per day
• One-to-one therapy
• A non-removable soft cast was used to constrain the less
affected arm and was kept on throughout the duration of
the programme
• Repetitive play-based task-specific activities, involving
challenging yet achievable goals that were progressively
made harder
• Shaping tasks:
• selecting tasks that were tailored to address the motor
deficits of the individual patient
• verbal feedback and verbal reward for small
improvements in task performance
• helping the patient to carry out parts of a movement
sequence if unable to do independently at first
• systematically increasing the difficulty of the task
OUTCOME MEASURE
CONCLUSIONS
• According to the results of this study, a 3-week intensive
CIMT programme was beneficial in improving function in
the hemiplegic upper limb in children.
• Further research:
• Long term effects and cost effectiveness of CIMT
• Effects of CIMT on various age groups
• Cast vs mitt as method of constraint
RESULTS
• All children apart from one improved in the domain of
amount of movement.
• Four children made clinically significant improvements, and
two of them improved but the results were not clinically or
statistically significant.
0
0.5
1
1.5
2
2.5
3
3.5
4
1 2 3 4 5 6 7
Amount of Movement
Before After
0
0.5
1
1.5
2
2.5
3
3.5
4
1 2 3 4 5 6 7
Quality of Movement
Before After
• All children improved in terms of quality of movement.
• Four of the seven children made a clinically significant
improvement.
• Paediatric Motor Activity Log (PMAL)
• A patient-evaluated measure
• 22 questions on unilateral and bilateral function of the
affected upper limb. Assesses quality of movement and
amount of use in their natural environment.
• Each item scored 0-5
• Assessment completed by parents at the start of the
programme and 2 weeks after the end of the programme.
• Children with hemiplegic cerebral palsy grow and develop
by using compensatory strategies to avoid using their
weaker side.
• Behaviourally: developmental disregard / learned non-use.
• Physiologically: use-dependent cortical reorganization and
this process can be reversed.