Pediatric Physical Therapy:
Section Information: Abstracts of Poster and Platform Presentations for the 2004 Combined Sections Meeting: Platform Presentations
E.L. Brekke, L.A. Ehler, J.A. Furze, C. Goulet, Physical Therapy, Creighton University, Omaha, NE.
BACKGROUND & PURPOSE: Constraint-induced therapy (CIT) has been used successfully to increase function in the involved upper extremity of selective populations of adults post stroke. Only a few case studies have documented the effectiveness of CIT in children with cerebral palsy. The purpose of this case study is to further supplement the current body of knowledge assessing the effects of CIT on upper extremity movement during functional activities in a child with cerebral palsy.
CASE DESCRIPTION: The child is a four-year-old boy with a medical diagnosis of spastic triplegic cerebral palsy. He had limited use of his left upper extremity, which limited his activities of daily living and ability to interact with his peers. The non-involved upper extremity was restrained for one hour twice a week for a period of four weeks plus home practice. During this time, the child performed functional and play activities utilizing his affected upper extremity. A motor activity log documenting the amount of time the restraint was worn at home and functional activities performed was completed by the child’s parents. The Wolf Gross Motor test and the fine motor portion of the Peabody Developmental Scales (2nd ed) were administered pre, immediately post, and three months post intervention.
OUTCOMES: Immediately following intervention, the child’s scores on the Wolf Gross Motor test improved from a mean of 15.9 seconds to 4.46 seconds and a median time of 2.5 seconds to 1.55 seconds. Peabody Developmental Motor Scales II raw scores improved from 4 to 8 on the grasping portion and 9 to 13 on the visual-motor integration section. The restraining device was worn for an average of 2.5 hours per day as reported on the Motor Activity Log. The three month follow-up assessment will be performed in October of 2003.
DISCUSSION: After four weeks of an adapted constraint induced therapy protocol, there was marked improvement in this child’s functional ability to use his affected upper extremity and interact with his peers. This case study indicates that constraint induced therapy can be effective with minimal use of the restraint. Thus, this type of intervention can be incorporated into a traditional clinical setting. Further research into the benefits and feasibility for constraint induced therapy for children with Cerebral Palsy is warranted.