Date Presented 04/06/19
This research explores how an eight-day CIMT camp improves postural symmetry in children with cerebral palsy. A pressure mapping system was used while participants engaged in functional static and dynamic tasks to assess how improvements in postural symmetry related to functional task performance. Improvements were found in both static sitting and standing tasks. The uses and feasibility of pressure mapping systems within clinical applications will also be explored.
Primary Author and Speaker: Aaron Dallman
Contributing Authors: Holly Holland, Margo Haynes, Kerry Blazek
PURPOSE: Children with hemiplegic cerebral palsy (hCP) demonstrate reduced participation in activities of daily living due to reduced fine motor coordination and balance impairments. Constraint induced movement therapy (CIMT) has been proven an effective intervention in improving fine motor outcomes in children with hCP. However, little is known about how CIMT impacts postural symmetry. Given that postural symmetry is one important component that enables fine motor performance in meaningful activities, it is important to identify interventions that can both improve symmetry while simultaneously improving functional performance.
DESIGN: Participants in this quasi-experimental study included 11 children aged 3-10 years with hCP who were able to ambulate without an assistive device. 11 age-matched typically developing (TD) peers also participated in the study. One participant with hCP was unable to complete the intervention due to sickness and thus that individual and their typically developing peer were excluded from the study. The children with hCP participated in an eight-day CIMT camp. During the camp, a novel combination of CIMT, bimanual intensive training, and therapeutic handling strategies formed the framework for intervention. Throughout the intervention, functional and meaningful activities were emphasized.
METHOD: For the participants with hCP, symmetry was measured at four time points (two pre-intervention and two post-intervention) using a Boditrak pressure-mapping system during both static standing and static sitting tasks. Given that symmetry was expected to remain relatively stable for TD individuals, the TD participants completed the postural symmetry assessment battery once. The postural symmetry assessment included a variety of static and dynamic tasks during both sitting and standing functional tasks. For static sitting tasks, the ischial tuberosities were identified among participants and both sides were compared. For static standing tasks, the heels and forefeet among participants were compared. A Wilcoxon-Signed Rank test was conducted to test for differences both within participants across time points and between groups.
RESULTS: Significant differences were found when pre-intervention was compared to post-intervention (n=10) in static sitting data between pre-intervention and one-month follow-up post-intervention (p<.05). Additionally, during static standing tasks, significant differences were found between pre-intervention and immediately post-intervention (p<.05) and between immediately post-intervention and one-month follow-up post-intervention (p<.05). Postural symmetry was not significantly different between individuals with hCP at the final point and their TD peers.
CONCLUSION: CIMT is an effective intervention for improving both fine motor performance and postural symmetry. The continued improvement observed after camp suggests that the effects of CIMT may continue beyond intervention cessation. These results have important implications for the occupational therapy practitioner. Occupational therapists should consider CIMT to address not only fine motor skills, but also postural impairments within the hCP population given that improvements in postural symmetry will facilitate greater functional gains within this population. Additionally, pressure mapping is an easy to implement, dynamic clinical tool that can be used readily in occupational therapy assessment and treatment within this population.
IMPACT STATEMENT: This work builds upon existing evidence for neuroplasticity among children – all the while demonstrating how a CIMT intervention can be used to facilitate functional improvements in meaningful activities of daily living by addressing both fine motor performance and postural symmetry.
References
Sakzewski, Leanne. (2012). Bimanual therapy and constraint-induced movement therapy are equally effective in improving hand function in children with congenital hemiplegia. Journal of Physiotherapy, 58(1), 59. doi:10.1016/S1836-9553(12)70075-9
Sterling, C., Taub, E., Davis, D., Rickards, T., Gauthier, L. V., Griffin, A., & Uswatte, G. (2013). Structural neuroplastic change after constraint-induced movement therapy in children with cerebral palsy. Pediatrics, 131(5), e1664-9. doi:10.1542/peds.2012-2051
Lee, I.-H., & Park, S.-Y. (2015). Abnormal sitting pressures of hemiplegic cerebral palsy children on a school chair. Journal of Physical Therapy Science, 27(2), 499–500. doi:10.1589/jpts.27.499
