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
PURPOSE: Constraint induced movement therapy (CIMT) is an intensive intervention in which the child's non-affected arm is constrained while the child is engaged in high intensity repetitive task practice using the affected arm [Ramey et al., 2019]. Through a grant funded by US AID, Vietnamese therapists were trained to use pediatric CIMT and developed models to use in the Vietnam healthcare system. The aims of this study: (1) to determine if two models of pediatric CIMT could be delivered with acceptable fidelity in two hospitals in Vietnam and (2) to determine if CIMT could improve the functional abilities of Vietnamese children with hemiplegic cerebral palsy (CP).
DESIGN: Prospective non-randomized study at two hospitals in Vietnam.
METHODS: Therapists at Hanoi Rehab Hospital delivered a low dose (30 hours) CIMT protocol while therapists in Ho Chi Minh City (HCMC) Children's Hospital delivered a high dose (72 hours) CIMT protocol. Children were diagnosed with hemiplegic CP and recruited from a sample of patients receiving therapy at each hospital. Outcome measures were the Goal Attainment Scale (GAS), ABILHAND-Kids, Pediatric Motor Activity Log (PMAL), and the Box and Blocks. GAS goals were set at baseline eval and ABILHAND Kids, PMAL, and Box and Blocks were administered at baseline, pre- and post-CIMT. Fidelity was measured using the CIMT Fidelity of Implementation Tool (4-point scale). Therapists video recorded two CIMT sessions each week; videos were viewed and rated. GAS converted to t-scores (mean of 50 and std. dev. of 10) and repeated measures ANOVA used for analysis of ABILHAND kids, PMAL, and box and blocks data.
RESULTS: Twenty children between 22 months to 6.9 years completed CIMT programs, 10 at each hospital (avg. age 3.5 yr. Hanoi, 4.6 yrs. HCMC). Both hospitals delivered CIMT program per protocol with fidelity scores above 2.5 indicating acceptable to high fidelity and adherence to CIMT protocols. GAS t-scores (62.7 for Hanoi, 52.8 for HCMC) indicate children met or exceeded individual goals. There was a significant difference (p < 0.05) between pre- and post-CIMT scores on ABIKHAND-Kids and PMAL at both hospitals and Box and Blocks scores for the HCMC group only (p = 0.015).
CONCLUSION: Therapists successfully partnered with families to implement CIMT, per protocol. Children in both low and high dose CIMT groups showed improvements in performance of everyday activities and individual therapy goals. These results are similar to recent pediatric CIMT studies implemented in the US when fidelity of treatment was measured (Ramey, et al., 2019). The results of this study advance the delivery of evidence-based practice in Vietnam and provide insight into how high quality CIMT can be provided in areas where resources are limited (i.e. rural areas).
IMPACT STATEMENT: This study is the first to examine the efficacy of newly developed pediatric CIMT models in Vietnam. The newly developed Vietnamese CIMT protocols will greatly impact the delivery of this evidence-based intervention in Vietnam and practitioners plan to extend training of new protocols to other countries in South-East Asia.
References
Ramey S.L., DeLuca S., Stevenson R.D., Case-Smith J., Darragh A. Conaway, M. (2019). Children with Hemiparesis Arm and Movement Project (CHAMP): protocol for a multisite comparative efficacy trial of pediatric constraint-induced movement therapy (CIMT) testing effects of dosage and type of constraint for children with hemiparetic cerebral palsy. BMJ Open, 9 (1).
Coker-Bolt, P., DeLuca, S., & Ramey, S. (2015). A partnership model to adapt and implement pediatric constraint-induced movement therapy (CIMT) in Sub-Saharan Africa. Occupational Therapy International, 22(3):141-51, https://doi.org/10.1002/oti.1392.
Pidcock, F. (2017). Pediatric Constraint Induced Movement Therapy: Harnessing Adaptive Neuroplasticity. Journal of Pediatric Rehabilitation and Medicine, 10(1); 1. https://doi.org/10.3233/PRM-170413.
