Caregiver Perceptions & Ability to Implement an Intensive Upper Limb Therapy Program in the Home Environment

PURPOSE: Pediatric constraint-induced movement therapy (P-CIMT) is an evidence-based intervention to improve hand function in children with unilateral cerebral palsy (UCP). However, the intensity may put an extra burden on caregivers. The aim of this study was to compare caregiver stress and the implementation rate of an 8-week (56 hour) P-CIMT program between two groups.

DESIGN: Prospective cohort study recruited from a tertiary center. Included children ages 3-59 months with asymmetric hand use who were at risk for developing CP or had a CP diagnosis. Excluded children with uncontrolled epilepsy, a significant visual impairment, or severe behavioral problems. Ten children with UCP (14-54 mo, 7 male, MACS II= 9, MACS III=1, 8 right hemiplegia) participated.

METHOD: The Canadian Occupational Performance Measure (COPM) was measured pre- and post-intervention. Caregiver stress was measured weekly using a 4 point Likert scale. T-tests analyzed differences between group outcomes and an ANCOVA was used to analyze COPM scores while controlling for pre-intervention scores and number of hours completed.

RESULTS: Statistically significant difference in the implementation rate between groups (t(9) = -2.310, p = .046, d = 1.39) with the 4-hour group completing an average of 57 hours compared to 43 hours completed by the 1-hour group. No statistically significant differences between the two groups for caregiver stress or COPM scores. However, there was a clinically significant difference in participant’s occupational performance, in favor of the 4-hour group, explained by their pretest scores (η2 = .464) and number of hours completed (η2 = .128).

CONCLUSIONS: Participants who engaged in the longer onsite sessions successfully completed the program hours, leading to clinically significant differences in occupational performance. Therapists should offer extended onsite sessions to offset caregiver responsibility and improve the implementation rates of intensive therapy.

References

Novak, I., Morgan, C., Fahey, M., Finch-Edmondson, M., Galea, C., Hines, A., Langdon, K., Namara, M. M., Paton, M. C., Popat, H., Shore, B., Khamis, A., Stanton, E., Finemore, O. P., Tricks, A., Te Velde, A., Dark, L., Morton, N., & Badawi, N. (2020). State of the Evidence Traffic Lights 2019: Systematic Review of Interventions for Preventing and Treating Children with Cerebral Palsy. Current Neurology and Neuroscience Reports, 20(2), 3. https://doi.org/10.1007/s11910-020-1022-z

Hoare, B., Wallen, M., Thorley, M. N., Jackman, M. L., Carey, L. M., & Imms, C. (2019). Constraint-induced movement therapy in children with unilateral cerebral palsy. Cochrane Database of Systematic Reviews, (4). https://doi.org/10.1002/14651858.CD004149.pub3