Date Presented 04/22/2023

Combined Approach to Treatment for Children with Hemiplegia (CATCH) is an organized approach of therapeutic interventions for children diagnosed with hemiplegia. Preliminary results from an evaluative study suggest that a play-based CATCH camp has a large effect on bilateral manual dexterity.

Primary Author and Speaker: Rachel M. Vaughn

Contributing Authors: Holly Holland, Kerry Blazek, Jessica M. Cassidy

PURPOSE: CATCH targets functional participation, postural symmetry, and manual dexterity for children with hemiplegia by blending principles from constraint-induced movement therapy (CIMT), bilateral intensive training (BIT), and neuro-developmental treatment (NDT). Literature highlights intervention and effects on the more-affected upper extremity (UE) but has not fully explored the impact on the less-affected UE or the use of a combined approach.

PURPOSE: to evaluate the effectiveness of a play-based CATCH-camp on manual dexterity for more- and less-affected UE. Hypothesis: CATCH-camp will positively influence manual dexterity for the more-affected UE and have minimal effect on less-affected UE.

DESIGN: This evaluative study included a play-based CATCH-camp cohort with pre- and post-testing. Camp application inclusion criteria: age 4-10 years, physician diagnosis of hemiplegia, and ability to ambulate without a device or assistance.

METHOD: CATCH-camp elements: 1) six days (6.5 hr/day) of structured play-based tasks emphasizing postural alignment (NDT), 2) CIMT 5.5hrs/day [day 1-3] then 4 hrs/day [day 4-6], 3) BIT remainder of day. Box & Blocks testing (BBT) was completed with campers for less- followed by more-affected UE at OT evaluation for CATCH-camp (∼30 days prior) and the last day of CATCH-camp. We calculated the effect size of CATCH-camp on more- and less-affected UE using a paired Cohen’s-d (pre- and post-camp BBT).

RESULTS: The camp cohort (N=21, 6 females, 7.0±1.8 years) completed BBT pre- and post-camp. Overall, CATCH-camp resulted in a large effect on manual dexterity for both less-affected UE (d=0.81) and more-affected UE (d=1.045). Preliminary findings suggest improved dexterity bilaterally following a play-based CATCH-camp.

CONCLUSION: This proposal impacts OT practice and research as it supplies evidence for the value of 1) a combined intervention approach and 2) play-based interventions for improving performance for more- and less-affected UE.


Boyd, R. N., Ziviani, J., Sakzewski, L., Miller, L., Bowden, J., Cunnington, R., Ware, R., Guzzetta, A., Al Macdonell, R., Jackson, G. D., Abbott, D. F., & Rose, S. (2013). COMBIT: Protocol of a randomised comparison trial of COMbined modified constraint induced movement therapy and bimanual intensive training with distributed model of standard upper limb rehabilitation in children with congenital hemiplegia. BMC Neurology, 13, 68.

de Brito Brandão, M., Gordon, A. M., & Mancini, M. C. (2012). Functional impact of constraint therapy and bimanual training in children with cerebral palsy: a randomized controlled trial. The American Journal of Occupational Therapy : Official publication of the American Occupational Therapy Association, 66(6), 672–681.

Holland, H., Blazek, K., Kaynes, M.P., & Dallman, A. (2019). Improving postural symmetry: The effectiveness of the CATCH (Combined Approach to Treatment for Children with Hemiplegia) protocol. Journal of Pediatric Rehabilitation Medicine, 12(2), 139-149.