Measuring the Long-Term Effects of Constraint-Induced Movement Therapy on Young Children to Improve Unilateral Function,Bimanual Performance,and Occupational Performance

PURPOSE AND BACKGROUND: The purpose of this study was to describe the long-term effects of group-based pediatric constraint-induced movement therapy (CIMT) with children aged 2–6 yr. CIMT has been found to be an effective intervention for children with upper extremity (UE) hemiparesis (Ramey & DeLuca, 2013). Limited research has investigated the long-term effects of CIMT beyond 6 mo in young children to determine whether the immediate gains from CIMT are maintained for a longer amount of time (Chen et al., 2014; Eliasson & Holmefur, 2007).

METHOD: For this quantitative repeated measures study, participants were four children aged 2–6 yr with unilateral hemiparesis from a Midwestern city who attended a group-based CIMT summer program in the camp room of a rehabilitation center in 2016 and completed follow-up testing 11 mo after completing the program. Exclusion criteria included child protective services custody and lack of parental consent. The Quality of Upper Extremity Skills Test (QUEST) was used to measure UE function, the Assisting Hand Assessment (AHA) was used to measure bimanual performance, the Canadian Occupational Performance Measure (COPM) and the Pediatric Evaluation of Disability Inventory (PEDI) were used to measure occupational performance, and demographic information was gathered using a questionnaire. Institutional review board approval was obtained.

Pretesting was done before the CIMT summer program began. The 4-wk CIMT summer program included 3 hr of occupational therapy with physical and speech therapy cotreatments. Participants wore a waterproof cast 24 hr/day for 3 wk and received bimanual therapy for the last week. Posttesting was done after the CIMT summer program ended, and follow-up testing occurred 11 mo afterward. Descriptive statistics were gathered, and repeated measures multivariate analyses of variance (MANOVAs) were performed.

RESULTS: The MANOVAs revealed significant pretest–posttest improvements for the following variables: QUEST total standard score, F(1, 4) = 358.14, p = .034; PEDI self-care functional skills normative scores, F(1, 4) = 1,011.24, p = .002; PEDI social function normative scores, F(1, 4) = 1,792.11, p = .015; PEDI self-care caregiver assistance normative scores, F(1, 4) = 411.51, p = .03; and PEDI self-care caregiver assistance scaled scores, F(1, 4) = 1,640.25, p = .016. From posttest to 11-mo follow-up, no significant differences were found on any of the variables, indicating that gains made from the CIMT summer program were retained nearly a year after the program ended. Furthermore, 13 of the 36 variables assessed (35%) had higher scores at 11-mo follow-up than at pre- and posttest. Nine variables (24%) had the highest scores at posttest, followed by 11-mo follow-up and then pretest, revealing that although these scores had declined at 11-mo follow-up from posttest, they still remained higher than baseline level.

CONCLUSION: Results should be interpreted cautiously because of sampling bias and maturation and cointervention effects (three participants received other therapy between posttest and 11-mo follow-up).

IMPACT STATEMENT: This study is one of the few to investigate long-term effects of CIMT. Findings reveal that CIMT intervention was an effective means of improving UE function and occupational performance immediately after intervention and that many of the gains were retained 11 mo after the intervention for the four children in this sample. This study helps fill the gap in research for this population.

References

Chen, H.-C., Chen, C.-L., Kang, L.-J., Wu, C.-Y., Chen, F.-C., & Huang, W.-H. (2014). Improvement of upper extremity motor control and function after home-based constraint induced therapy in children with unilateral cerebral palsy: Immediate and long-term effects. Archives of Physical Medicine and Rehabilitation, 95, 1423–1433. https://doi.org/10.1016/j.apmr.2014.03.025

Eliasson, A., & Holmefur, M. (2007). The influence of early modified constraint-induced movement therapy training on the longitudinal development of hand function in children with unilateral cerebral palsy. Developmental Medicine and Child Neurology, 57, 89–94. https://doi.org/10.1111/dmcn.12589

Ramey, S. L., & DeLuca, S. C. (2013). Pediatric CIMT: History and definition. In S. L. Ramey, P. Coker-Bolt, & S. C. DeLuca (Eds.), Handbook of pediatric constraint-induced movement therapy (CIMT): A guide for occupational therapy and health care clinicians, researchers, and educators (pp. 3–17). Bethesda, MD: AOTA Press.