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Commentary on “Modified Constraint-Induced Movement Therapy as a Home-Based Intervention for Children With Cerebral Palsy”

Rabin, Laura MA, OTR/L; Dittbenner, Lisa BS, OTR/L; Sarreal, Ana; Sarreal, Joey

Pediatric Physical Therapy: July 2016 - Volume 28 - Issue 2 - p 161
doi: 10.1097/PEP.0000000000000256
Clinical Bottom Line

California Children's Services, County of Los Angeles, North Hollywood, California

California Children's Services, County of Los Angeles, El Monte, California

Parents of a teenager with hemiplegia from a cerebral vascular accident, Los Angeles, California

The authors declare no conflicts of interest.

“How could I apply this information?”

With 1 to 2 hours of daily restraint wear and training, the results of this study showed that children with hemiplegic cerebral palsy improved upper limb function. This home-based program offers families a viable alternative to intensive, clinic-based constraint-induced movement therapy (CIMT). Parents may feel empowered that after training, they can work with their child at home to produce meaningful results, without relying on a therapist to provide hands-on intervention. The lower assessment scores recorded 1 month post-intervention suggest that continued home activities are necessary to maintain skills.

Parent comments: We are encouraged by the results of this study because they may apply to our son whose limited upper limb function resulted from a stroke. Home-based CIMT could augment the therapy he receives in the clinic. It might also afford him the luxury of being relaxed and able to do it on his own time, in a familiar setting.

“What should I be mindful about when applying this information?”

Finding the right fit between the child, family, and home or clinic-based protocol is integral to meeting the needs of everyone involved. Subjects participated in 60% of the recommended training hours, which is 10% to 20% more than other home-based CIMT.1 The interactive video game may have improved adherence; however, it is unclear whether increased test scores resulted from the game or additional weeks of training.

The article excluded details of the family training, so inexperienced clinicians who follow the protocol might implement a forced use program. Parents only logged quantitative data. Qualitative data and a quality of life measure may be appropriate to further assess home-based interventions. Reporting individual test scores beyond baseline may assist with data interpretation, given the variability in the subjects' restraint wear times. Results from a longer follow-up period would be helpful to inform third-party payers and to increase buy-in from clients and families.

Parent comments: Future studies may want to consider asking each child to do therapy for the same number of hours each day and days per week. Subjects could be categorized by age and sex because both may influence results.

Our son, like most children, was inconsistent with doing CIMT at home. However, we saw a marked improvement after a few days. Although it may be challenging and uncomfortable for a child to wear a constraint on his or her good arm, we recommend a strict daily routine to help with adherence. So far, we are very satisfied with our son's improved arm function, knowing that his road to full recovery is long.

Laura Rabin, MA, OTR/L

California Children's Services, County of Los Angeles

North Hollywood, California

Lisa Dittbenner, BS, OTR/L

California Children's Services, County of Los Angeles

El Monte, California

Ana and Joey Sarreal

Parents of a teenager with hemiplegia from a cerebral vascular accident

Los Angeles, California

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1. Eliasson AC, Krumlinde-Sundholm L, Gordon AM, et al. Guidelines for future research in constraint-induced movement therapy for children with unilateral cerebral palsy: an expert consensus. Dev Med Child Neurol. 2013;56:125–137.
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