Pediatric Constraint-Induced Movement Therapy: Current Practices and Implementation Barriers

Abstract

Hemiplegic Cerebral Palsy (CP) is the most common pediatric motor disability, characterized by unilateral motor weakness. Pediatric Constraint-Induced Movement Therapy (pCIMT) improves affected extremity function but faces variable clinical integration. This study assessed U.S. providers’ awareness and use of pCIMT, educational practices, and barriers to broader implementation for more eligible children. Overall, 148 providers specializing in pediatric stroke or hemiplegic CP completed surveys on pCIMT familiarity, implementation challenges, and support for evidence-based practices (EBP). Participants indicated high pCIMT competency. Although 75% reported regional pCIMT availability, only 14% indicated that pCIMT is accessible to all children who could benefit. Reported barriers included therapist and family availability, cost, and institutional limitations. Despite valuing EBP, participants reported minimal workplace support for its use. The study revealed significant barriers to pCIMT accessibility and implementation. Further research is needed to address these challenges and improve clinical adoption of EBP, such as pCIMT.

Plain Language Summary

Understanding How to Get a Targeted Movement Intervention to All Children With One-Sided Weakness in the United States

Hemiplegic Cerebral Palsy (CP) affects movement on one side of the body and is the most common pediatric movement disorder. Pediatric Constraint-Induced Movement Therapy (pCIMT) improves the use of the affected limb, but it is not widely used. We wanted to understand why and figure out where and how it is being offered. We surveyed 148 professionals in health care and academia about their awareness of pCIMT, what makes it hard to use, whether pCIMT is offered near them, and about workplace support for evidence-based treatments. The survey also asked how pCIMT is typically provided, including how long treatments last, type of constraint, and constraint wearing schedule. Most providers reported awareness of and local availability of pCIMT. However, they reported that not all children who might benefit from it had access. The main obstacles that were identified were finding enough time for therapists and families, the cost of treatment, and limits set by health care facilities. In addition, pCIMT programs were reported to vary widely in how they were structured and delivered, which could affect how well they work. Workplaces generally supported evidence-based practices but did not always make them a top priority. Better understanding provider’s perspectives about pCIMT, how it is currently offered, and obstacles to availability can aid in the identification of implementation strategies to address the challenges that make it difficult for providers to offer widely. Future research can investigate the impact of educating therapists about its benefits and how it can be covered by insurance/ Medicaid; the use of flexible guidelines for pCIMT programs that can be adapted to different settings and patient needs; and specialized training.