Clinical Bottom Line
“How could I apply this information?”
This article reminds us that the human body is an interactive chain and more than a string of independent parts. Outcome measures for constraint-induced movement therapy (CIMT) programs typically do not address gait, functional locomotor mobility, or balance, but this intervention logically extends to the possible improvement in these outcomes. It is important to look past the effects of CIMT on upper extremity activities and consider what occurs further down the chain. Improved interlimb coordination and trunk rotation can positively affect gait efficiency.
Although the results were limited, the improvements seen were “by-products” of the 3-week CIMT protocol. There may have been greater improvement if the intervention included a specific focus on the involved upper extremity during gait and higher-level balance tasks. The authors suggest that a longer practice period would allow children to reinforce new motor patterns and become more proficient in these areas; however, including functionally relevant goals that relate to incorporating the upper extremity in gross motor activities might produce improved outcomes even within a 3-week protocol.
A multidisciplinary approach to CIMT may yield the best overall outcomes. If occupational therapists are the providers of CIMT in a clinic, then physical therapy intervention, either during or immediately following the intensive episode of care could focus on incorporating the upper extremities during gait and balance.
What should I be mindful about when applying this information?
The small sample size and use of nonparametric statistics made it challenging to find statistically significant results using the standard, but somewhat arbitrary P value of .05. The Pediatric Balance Scale had a P value of .06 that should be considered and the authors did so. They provide a more detailed analysis that gives us greater insight into the changes that did occur with the intervention and informs future research. The authors also recognized limitations in the outcome measures chosen and suggested alternatives for future studies that are more appropriate or sensitive to the variables being considered.
Stephanie Yu, PT, MSPT, PCS
County of Los Angeles, California Children's Services,
Long Beach Medical Therapy Unit, Long Beach, California
Linda Fetters, PT, PhD, FAPTA
University of Southern California, Los Angeles, California