Date Presented 04/05/19
This poster will discuss a research study measuring the effects of multiple dosages of a pediatric constraint induced movement therapy (pCIMT) summer camp program for children two to six years of age. Children attended two summer CIMT programs two years in a row and were assessed using the same outcomes. Methodology and results will be shared.
Primary Author and Speaker: Katherine Ryan-Bloomer
Additional Authors and Speakers: Michelle Deves, Haley Padgett, Nichelle Meyer, Jenna Richardson, Jordan Shy, Bethany Tackett
PURPOSE/RATIONALE: The purpose of this study is to discuss the effects of multiple dosages of pediatric constraint induced movement therapy (pCIMT) intervention on unilateral function, bimanual coordination, and occupational performance in young children with unilateral hemiparesis. P-CIMT has been found to be an effective intervention for children with upper extremity (UE) hemiparesis (Ramey & DeLuca, 2013). There is limited research investigating the effects of multiple dosages of pCIMT in young children to determine if the immediate gains from CIMT are maintained for a longer period of time after multiple sessions of treatment (Case-Smith, DeLuca, Stevenson, & Ramey, 2012; DeLuca, Ramey, Trucks, & Wallace, 2015). Even few studies have investigated the effects of multiple dosages of CIMT within consistent time-frames. This study aimed to rectify these gaps in the literature.
DESIGN: Quantitative repeated measures design. (Pre-camp 1, post-camp 1, pre-camp 2, post-camp 2)
PARTICIPANTS: Participants included eight children with unilateral hemiparesis ages two to six who participated in two CIMT summer program interventions and who were not in protective custody.
SETTING: Rehabilitation clinic in an urban Midwest city
INSTRUMENTS: upper extremity function: Quality of Upper Extremity Skills Test (QUEST), Bimanual performance: Assisting Hand Assessment (AHA), and Occupational Performance: Canadian Occupational Performance (COPM) and the Pediatric Evaluation of Disability Inventory (PEDI), demographic questionnaire.
PROCEDURE:
1. IRB approval
2. Training of all students and volunteers on CIMT principles, competency checklists
3. Pre-testing before the CIMT summer program
4. Participants attended a 4 week group-based CIMT summer program- 4 weeks of camp: 3 hours of OT with PT and ST co-treats, waterproof cast worn 24 hours per day x 3 weeks, bimanual therapy for last week. Weekly and daily themes were implemented.
5. Post-CIMT summer program testing
6. Repeated steps 3-5 for children returning for a second dosage of CIMT intervention 1 year later.
DATA ANALYSIS: Descriptive statistics, repeated measures multivariate analyses of variance (MANOVAs) were performed.
RESULTS: We expect statistically significant (SS) improvements in unilateral function, bimanual coordination, and occupational performance. The following scores are also expected:
*Post-camp 1 SS > Pre-camp 1
*Post-camp 2 SS > Post -camp 1
*No SS difference between post-camp 1 and pre-camp 2
*Post-camp 2 SS > Post camp 2
Four participants have already completed two dosages of CIMT intervention and the remaining four have begun the second dosage on June 4, 2018 and will complete the second intervention by the end of June 2018.
DISCUSSION: Results of this study will help fill a gap in the literature and provide important information about whether children may benefit from multiple dosages and if the original gains are retained and built upon. Limitations include sampling bias and intervention bias. Though fidelity measures were implemented to ensure intervention was applied consistently between CIMT interventions, some children received individual OT in between. Implications for future research: expand sample size and diagnoses included.
CONCLUSION/IMPACT STATEMENT: This study would add to the very limited research investigating the effect of multiple dosages. If found to be effective, multiple dosages of p-CIMT may provide a viable option for children with hemiparesis as they age. Children could attend intensive CIMT summer programs during breaks from school to build upon improvements from year to year. The group-based model may enable therapists to treat more children at a time and enable greater opportunities for social participation.
References
DeLuca, S. C., Ramey, S. L., Trucks, M. R., & Wallace, D. A. (2015). Multiple treatments of pediatric constraint-induced movement therapy (pCIMT): A clinical cohort study. American Journal of Occupational Therapy, 69, 6906180010. http://dx.doi.org/10.5014/ajot.2015.019323
Case-Smith, J., DeLuca., S. C., Stevenson, R., & Ramey, S. L. (2012). Multicenter randomized controlled trial of pediatric constraint-induced movement therapy: 6-month follow-up. American Journal of Occupational Therapy, 66, 15–23. doi:10.5014/ajot.2012.002386
Ramey, S. L., & DeLuca, S. C. (2013). Pediatric CIMT: History and Definition. In Ramey, S. L., Coker-Bolt, P., & DeLuca, S. C. Pediatric constraint-induced movement therapy (CIMT): A guide for occupational therapy and health care clinicians, researchers, and educators (pp.3-17).Bethesda, MD: American Occupational Therapy Association, Inc.
