Date Presented 03/27/20
This panel will discuss a research study measuring the effects of intensive, group-based CIMT for children with hemiplegia who are ages nearly two to six years old. Results produced many statistically significant improvements in unilateral function, bimanual coordination, and occupational performance, including social participation.
Primary Author and Speaker: Katherine Ryan-Bloomer
Additional Authors and Speakers: KayLee Farmer, Alexandra Goossen, Jessie Tien, Molly Vaeth, Bethany Tackett
PURPOSE/RATIONALE: Numerous studies have revealed positive effects in children following individual, signature Constraint Induced Movement Therapy (CIMT) (Deluca, et al., 2017). Limited research has found group-based CIMT to improve bimanual, fine motor, and functional skills in children with hemiplegic cerebral palsy (CP, Pawlak, et al., 2017; Sakzewski, et al., 2015; Wu, et al., 2013). Few CIMT studies have utilized an intensive dosage, nor explicitly investigated social participation for young children with congenital and acquired hemiplegia. This study aimed to address these gaps in the literature by measuring the efficacy of intensive, group-based CIMT intervention to improve unilateral function, bimanual coordination, and occupational performance including social participation in young children ages nearly two through six with hemiplegia.
RESEARCH DESIGN: One group, Pre-post design. Hypotheses: Following intensive, group-based CIMT, participants will display statistically significant improvements in 1) unilateral function as measured by the QUEST, 2) bimanual coordination as measured by the AHA, and 3) occupational performance as measured by the COPM and PEDI.
METHODS: Participant Demographics: N = 22 children ages 21 to 67 mos (mean age 35 mos) with congenital and acquired hemiplegia; Data reported on 14 participants who have completed pre-post testing (8 participants currently attending the 2019 CIMT summer program)
SETTING: Midwest rehabilitation clinic in USA
INSTRUMENTS: Quality of Upper Extremity Skills Test (QUEST), Assisting Hand Assessment (AHA), and Occupational Performance: Canadian Occupational Performance Measure (COPM) and the Pediatric Evaluation of Disability Inventory (PEDI) – Self-care and Social Function domains, demographic questionnaire
PROCEDURE: IRB approval & training
PRE-TESTING: Participants attended the 2-3 or 4-6 year-old intensive, group-based CIMT summer program: OT 3 hrs/ day x 5 days per wk with PT/ST co-treatments, waterproof cast worn 24 hours per day x 3 wks, bimanual therapy for last wk. Same theme-based lesson plans used.
POST-TESTING
DATA ANALYSIS: Descriptive statistics, repeated measures multivariate analyses of variance (MANOVAs)
RESULTS: Statistically significant improvements in the following:
Hypothesis 1 partially accepted:
Dissociated movements: F (1,14) = 5.27, p = .043, p2 = .323
Weight bearing: F (1,14) = 11.67, p = .006, p2= .515
Protective extension: F (1,14) = 5.61, p = .037, p2= .338
Total QUEST score: F (1,14) = 16.51, p = .002, p2= .6
Hypothesis 2 accepted:
AHA F (1,14) = 21.57, p <.001, p2= .624
Hypothesis 3 partially accepted:
Self-Care Functional Skills Scaled score: F (1,14) = 8.902, p = .011, p2= .406
Social Function Scaled score: F (1,14) = 19.26, p = .001, p2= .597
Self-Care CA Scaled: F (1,14) = 19.87, p = .011, p2= .604
Eating: F (1,14) = 6.05, p = .024, p2= .333
Bladder: F (1,14) = 5.692, p = .033, p2= .406
COPM Performance: F (1,14) = 49.45, p < .001, p2= .792
COPM Satisfaction: F (1,14) = 26.91, p <.001, p2= .674
DISCUSSION: Intensive, group-based CIMT intervention was an effective method of delivery for improving unilateral function, bimanual coordination, and occupational performance including social participation for this sample of young children with hemiplegia. Limitations: sampling, measurement, and intervention bias- reduced by fidelity measures and stringent training.
CONCLUSION/IMPACT STATEMENT: Intensive, group-based CIMT performed with young children maximizes neural plasticity and provides an opportunity to improve social participation and play with peers. The intensive group-based model enables OTs opportunities to treat more children, thus promoting occupational justice.
References
DeLuca, S.C., Trucks, M.R., Wallace, D.A., & Ramey, S.L. (2017). Practice-based evidence from a clinical cohort that received pediatric constraint-induced movement therapy. Journal of Pediatric Rehabilitation Medicine: An Interdisciplinary Approach, 10, 37-46. Doi: 10.5014/ajot.2015.019323
Pawlak, M., Wnuk, B., Kowalicka, D., Rosłoniec, A. (2017). Upper limb therapy in children with cerebral palsy (CP) - The Pirate Group. Advances in Rehabilitation, 31 (4), 57-67. Doi: 10.1515/rehab-2015-0079
Sakzewski, L., Miller, L., Ziviani, J., Abbott, D.F., Roses, S., MacDonell, R.A., & Boyd, R.N. (2015). Randomized comparison trial of density and context of upper limb intensive group versus individualized occupational therapy for children with unilateral cerebral palsy. Developmental Medicine & Child Neurology, 57, 539–547. doi: 10.1111/dmcn.12702
Wu, W.-C., Hung, J.-W., Tseng, C.-Y., & Huang, Y.-C. (2013). Group constraint-induced movement therapy for children with hemiplegic cerebral palsy: A pilot study. American Journal of Occupational Therapy, 67, 201–208. doi: 10.5014/ajot.2013.004374
