Efficacy of Intensive, Group-Based Intensive Constraint-Induced Movement Therapy (CIMT) in Young Children With Hemiparesis

PURPOSE/RATIONALE: Numerous studies have revealed positive effects in children following individual, signature Pediatric Constraint Induced Movement Therapy (P-CIMT) (Deluca et al., 2012; Deluca et al., 2017; Garcia-Reidy et al., 2012). Few studies have evaluated the effects of intensive, group-based P-CIMT with young children with hemiparesis (Komar et al., 2016; Wu, et al., 2013). This study aimed to measure the efficacy of intensive, group-based P-CIMT intervention to improve unilateral function, bimanual coordination, and occupational performance including social participation in young children ages two through six with hemiparesis. Research.

DESIGN: One group, Pre-post design. Hypotheses: Following intensive, group-based P-CIMT, participants will display statistically significant improvements in 1) unilateral function as measured by the QUEST, 2) bimanual coordination as measured by the AHA, and 3) occupational performance as measured by the COPM and PEDI.

METHOD: • Participant Demographics: N = 25 children ages 21 to 67 mos (mean age 35 mos) with congenital and acquired hemiplegia; Data reported on 21 participants who have completed pre-post testing (4 participants currently attending the 2021 CIMT summer program) • Setting: Midwest rehabilitation clinic in USA • Instruments: Quality of Upper Extremity Skills Test (QUEST), Assisting Hand Assessment (AHA), and Occupational Performance: Canadian Occupational Performance (COPM) and the Pediatric Evaluation of Disability Inventory (PEDI) – Self-care and Social Function domains, demographic questionnaire • Procedure: • IRB approval & training • Pre-testing • Participants attended the 2-3 or 4-6 year-old intensive, group-based CIMT summer program: OT 3 hrs/ day x 5 days per wk with PT/ST co-treatments + music and art; cast worn 24 hours per day x 3 wks, bimanual therapy for last wk. Same theme-based lesson plans used. • Post-testing • Data analysis: Descriptive statistics, repeated measures multivariate analyses of variance (MANOVAs).

RESULTS: Statistically significant improvements found prior to summer 2021 CIMT program: Hypothesis 1 partially accepted: • Dissociated movements: F (1,17) = 7.697, p = .014, Ꞃp2 = .325 • Weight bearing: F (1,17) = 9.017, p = .008, Ꞃp2 = .360 • Protective extension: F (1,17) = 4.452, p = .051, Ꞃp2 = .218 • Total QUEST score: F (1,17) = 12.958, p = .002, Ꞃp2 = .447 Hypothesis 2 accepted: • AHA F (1,21) = 53.94, p <.001, Ꞃp2 = .730 Hypothesis 3 partially accepted: • Self-Care Functional Skills Scaled score: F (1,21) = 13.63, p = .001, Ꞃp2 = .405 • Social Function Scaled score: F (1,21) = 12.029, p = .002, Ꞃp2 = .376 • Self-Care CA Scaled: F (1,21) = 12.34, p = .002, Ꞃp2 = .382 • Eating: F (1,21) = 7.67, p = .012, Ꞃp2 = .277 • Upper Extremity Dressing: F (1,21) = 4.706, p = .042, Ꞃp2 = .190 • COPM Performance: F (1,21) = 82.31, p < .001, Ꞃp2 = .805 • COPM Satisfaction: F (1,21) = 51.07, p <.001, Ꞃp2 = .719.

DISCUSSION: Intensive, group-based CIMT intervention was an effective method of delivery for improving unilateral function, bimanual coordination, and occupational performance for this sample of young children with hemiparesis. Limitations: sampling, measurement, and intervention bias- reduced by fidelity measures and stringent training.

CONCLUSION/IMPACT STATEMENT: Intensive, group-based CIMT performed with young children maximizes neural plasticity and provides an opportunity to improve social participation and play with peers. Additionally, the intensive group-based model enables more children to access this intervention while providing an opportunity for universality and modeling.

References

DeLuca, S.C., Trucks, M.R., Wallace, D.A., & Ramey, S.L. (2017). Practice-based evidence from a clinical cohort that received pediatric constraint-induced movement therapy. Journal of Pediatric Rehabilitation Medicine: An Interdisciplinary Approach, 10, 37-46. https://doi.org/10.5014/ajot.2015.019323

Garcia-Reidy, T., Naber, E., Viguers, E., Allison, K., Brady, K., Carney, J., Salorio, C., & Pidcock, F. (2012). Outcomes of a clinic-based pediatric constraint induced movement therapy program. Physical & Occupational Therapy in Pediatrics, 32 (4), 355-367. https://doi.org/10.3109/01942638.2012.694991

Komar, A., Ashley, K., Hanna, K., Lavallee, J., Woodhouse, J., Bernstein, J., Andres, M., Reed, N. (2016). Retrospective Analysis of an Ongoing Group-Based Modified Constraint-Induced Movement Therapy Program for Children with Acquired Brain Injury. Physical and Occupational Therapy in Pediatrics, 36(2). https://doi.org/10.3109/01942638.2015.1076557

Wu, W.-C., Hung, J.-W., Tseng, C.-Y., & Huang, Y.-C. (2013). Group constraint-induced movement therapy for children with hemiplegic cerebral palsy: A pilot study. American Journal of Occupational Therapy, 67, 201–208. https://doi.org/10.5014/ajot.2013.004374