Date Presented 04/8/21 Vietnamese therapists developed constraint-induced movement therapy (CIMT) models and completed a prospective nonrandomized study at two hospitals in Vietnam. Therapists at Hanoi Rehab Hospital delivered a low-dose (30-hour) CIMT protocol, and therapists in Ho Chi Minh City Children's Hospital delivered a high-dose (72-hour) CIMT protocol. Children in both low- and high-dose CIMT groups showed improvements in everyday activities and individual therapy goals. This study advances the delivery of evidence-based practice in Vietnam. Primary Author and Speaker: Patricia Coker-Bolt Additional Authors and Speakers: Katherine Breithaupt Contributing Authors: Lauren Williams

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. Roger's Diffusion of Innovation Theory was used to examine the extent to which practitioners have adopted use of constraint-induced or modified constraint-induced movement therapy, both well supported by research, into neurorehabilitation practice. Although perceived effective, few use it even with eligible clients. Findings of this study provide insight into strategies that may increase consumer access to evidence-based practice to improve occupational performance and participation after stroke. Primary Author and Speaker: Shannon L. Scott Contributing Authors: Leah Arpadi, Margaret Crowell, Alexis Levine, Molly Lynch, Ali Muro, and Hannah Shade

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. This proposal will present and review data from a fidelity-of-intervention tool currently used to evaluate the fidelity of implementation in pediatric constraint-induced movement therapy (pCIMT). Measuring treatment fidelity in OT environments will allow therapists to translate core components of therapies that have been scientifically validated as efficacious. This is critical for pCIMT as it is widely used in the treatment of children with hemiparesis across clinical settings Primary Author and Speaker: Megan D. Price Contributing Authors: Stephanie DeLuca, Sharon Landesman Ramey, Amy Darragh, and Rich Stevenson

Date Presented 04/13/21 Children with unilateral cerebral palsy participating in repeat doses of pediatric constraint-induced movement therapy camp augmented with the Hocoma Armeo®Spring demonstrated significant improvements in hand function and bimanual performance for both doses and showed a generalized upward trend in hand function over time. Primary Author and Speaker: Heather Roberts Additional Authors and Speakers: Sara P. Johnston, David Plutschack

Date Presented 04/23/21 This scoping review aims to identify current evidence for constraint-induced movement therapy (CIMT) protocols, clinical applications for practice, and gaps in research for CIMT in infants and toddlers with unilateral cerebral palsy. The study will provide an overview of emerging research in CIMT that is critical for providing evidence-based practice. Primary Author and Speaker: Casey Walker Contributing Authors: Danielle Lowinger, Sara Rezak

OBJECTIVE. We examined the effectiveness of modified constraint-induced movement therapy (mCIMT) in treating infants with hemiplegic cerebral palsy and compared therapy outcomes with a nonconstraining bimanual therapy (BIM) of equal intensity. METHOD. In a single-blinded randomized controlled trial, 33 infants with hemiplegia (mean corrected age = 11.1 mo, standard deviation = 2.2) received either mCIMT (n = 17) or BIM (n = 16). Both interventions included home programs encouraging the use of the affected hand during daily 1-hr play sessions for 8 wk. Outcome measures were administered pre- and posttreatment and included the Mini-Assisting Hand Assessment for babies and the Functional Inventory. At baseline, parents also filled out the Dimensions of Mastery Questionnaire. RESULTS. Both groups demonstrated a significantly large and equal improvement in hand and gross motor function posttreatment (p < .001) and high treatment compliance. CONCLUSION. mCIMT and BIM are equally effective methods for treating infants with hemiplegia.

OBJECTIVE. We investigated the feasibility and effectiveness of group-based constraint-induced movement therapy (CIMT) for children with hemiplegic cerebral palsy in a clinical setting. METHOD. Seven children received CIMT together under the guidance of two occupational therapy practitioners, 2.5 hr/day, 5 days/wk for 4 wk. We used the Grasping and Visual–Motor Integration subtests of the Peabody Developmental Motor Scales to assess the primary outcome and the Functional Skills and Caregiver Assistance Scales of the Pediatric Evaluation Disability Inventory to assess the secondary outcome. Children were examined at preintervention, postintervention, and 1- and 3-mo follow-up. RESULTS. Children demonstrated significant improvement on all outcome measures after intervention (all ps < .05, effect sizes = .39–.84), and effects were maintained at 3-mo follow-up. CONCLUSION. This preliminary study revealed that group-based CIMT for children with hemiplegic cerebral palsy may be a feasible and effective alternative to individual CIMT in clinical practice.

OBJECTIVE. We investigated the effect of constraint-induced therapy (CIT) plus eye patching (EP), CIT alone, and conventional treatment on functional performance, eye movement, and trunk–arm kinematics in stroke patients with neglect syndrome. METHOD. Twenty-four participants were recruited and randomly allocated to three intervention groups. All participants received intervention 2 hr/day, 5 days/wk, for 3 wk. Outcome measures included the Catherine Bergego Scale, eye movement, and trunk–arm kinematic analysis. RESULTS. The CIT + EP and CIT groups demonstrated larger improvements in functional performance than the control group. The CIT group showed better performance with left fixation points than the CIT+EP group and shorter reaction time than the control group. The CIT + EP group improved more in preplanned control and leftward trunk shift than the other two groups. CONCLUSION. CIT + EP and CIT were more effective interventions than conventional treatment of patients with neglect syndrome in daily functional performance.

OBJECTIVE. We compared children’s self-care performance and caregivers’ perception of children’s performance on functional goals established for children with hemiplegic cerebral palsy (CP) after unimanual constraint-induced movement therapy (CIMT) or hand–arm bimanual intensive training (HABIT). METHOD. Sixteen children with CP were randomized to the CIMT or HABIT group. Interventions lasted for 15 days, 6 hr/day, totaling 90 hr. We used the Pediatric Evaluation of Disability Inventory and the Canadian Occupational Performance Measure (COPM) to assess the children’s daily functioning and mixed analyses of variance to compare group means on functional test scores before and after intervention. RESULTS. Both groups showed significant improvements on functional measures. Group × Assessment interaction in COPM performance revealed greater improvements for the HABIT group after intervention (p = .04). CONCLUSION. The results suggest that specificity of training exists only for performance of specific goals established by parents and that both CIMT and HABIT can be used to increase children’s daily functioning.

OBJECTIVE. Upper-extremity functional improvements after constraint-induced movement therapy have not been documented beyond 2 years. This case report describes the long-term maintenance of the effects of change 4–5 years after an application of constraint-induced therapy. METHOD. A 36-year-old female poststroke patient participated in constraint-induced therapy for 2 weeks. She was evaluated before and after treatment and again 4 and 5 years later. Primary outcome measures included the Wolf Motor Function Test, Stroke Impact Scale, and Motor Activity Log. RESULTS. Improvements were maintained in reported use and ability of the arm and hand, time to complete functional tasks, and physical aspects of health-related quality of life. Fatigue may have had a moderating effect on the extent of these changes. CONCLUSION. Improved upper-extremity function continued over a 5-year period after constraint-induced therapy; however, poststroke fatigue remained an influential limiting factor.

OBJECTIVE. This case report describes the use of modified constraint-induced movement therapy (CIMT) to improve upper-limb function in a 12-month-old child with right hemiplegia. It also describes parent concerns about CIMT and documents the short- and long-term effects of modified CIMT. METHOD. The participant was assessed 5 times over a 7.5-month period using the Peabody Developmental Motor Scales–2, Pediatric Motor Activity Log, Toddler Amount of Use Test, and Knox Parent Questionnaire. CIMT included a nonremovable cast worn on the unaffected arm and approximately 8 hr per week of occupational and physical therapy for 2 weeks. RESULTS. Benefits of improved upper-limb function measured immediately after CIMT were sustained at 6 months’ follow-up. No adverse events related to cast use were reported. DISCUSSION. The findings from this case report suggest that CIMT was a safe intervention associated with improving upper-limb function for this young child with hemiplegia.

The authors examined changes associated with constraint-induced movement therapy (CIMT) provided to a preschool-aged child with right spastic hemiplegia. This case study design used a 2-week pretest measure baseline period, 2 weeks of CIMT, and postmeasures at 1 week and 3 months. Measures were chosen to document changes at the different levels of International Classification of Functioning, Disability and Health (ICF), including the Canadian Occupational Performance Measure (COPM), Pediatric Evaluation of Disability Inventory (PEDI) Self-Care Section, Melbourne Assessment of Unilateral Upper Limb Function, and grip and pinch strength. Results showed increases on COPM-identified goals of increased independence with bilateral hand play and participation in gross motor play with friends. Changes were also documented in self-care, arm function, and grip strength. Another unexpected association reported by parents and professionals was increased speech intelligibility. Potential implications of implementing CIMT with young children are presented.

This study describes a single-subject design (ABA with follow-up evaluation) that demonstrated the possible effective use of constraint-induced movement therapy (CIMT) in producing gains in movement and function for a 24-month-old child with chronic hemiparesis. The noninvolved upper extremity was placed in a removable splint for 21 consecutive days. The child was involved in intensive occupational therapy in the home environment. Daily measurements were completed on the use and quality of motion of the involved upper extremity for eight specific fine and gross motor activities. Change in performance and quality of movement were measured and significant at the p < .05 level with the calculation of the C statistic for the motor activities with gains maintained after completion of the treatment and postsplinting phases. The results of the study contribute to the body of evidence finding CIMT to be effective for increasing movement and function in children with hemiparesis.

Modified constraint-induced movement therapy (mCIMT) is a reimbursable regimen that improves the use and function of more-affected arms in patients who have had a stroke. To participate in this regimen, however, patients must exhibit active extension of the more-affected wrists and fingers, which renders many people ineligible. This study determined the efficacy of a mental practice program that preceded mCIMT in improving more-affected arm function in 4 patients with a stroke. Patients received therapy emphasizing activities of daily living (ADLs), followed by sessions of mental practice of the ADL. One week after completing mental practice, patients participated in mCIMT. After mental practice, patients exhibited marked changes on assessments and increased active wrist and finger extension, which qualified them for mCIMT. After mCIMT, participants exhibited additional functional gains, sustained 3 months later. Data suggest that mental practice provides a pathway whereby patients can participate in mCIMT, realize additional gains, and again perform valued ADLs.

The purpose of this study was to explore and describe the perceptions and experiences of two survivors of stroke who participated in constraint-induced movement therapy (CIMT) home programs. Data sources were analyzed with a phenomenological approach, and common themes were identified. Themes were translated using the Occupational Adaptation frame of reference as a template. Three themes were generated from the data: (a) motivational factors and expectations represented personal desires to increase functional ability and environmental demands that created a press to participate in CIMT; (b) neurorehabilitation as an ongoing process suggested that rehabilitation should continue as long as functional deficits exist; and (c) perceived changes in function represented perceived changes in efficiency, effectiveness, and satisfaction after CIMT. CIMT was found to help the participants in this study become more satisfied with performance and to increase efficiency and effectiveness of function in daily activities.