Date Presented 04/23/21
This scoping review aims to identify current evidence for constraint-induced movement therapy (CIMT) protocols, clinical applications for practice, and gaps in research for CIMT in infants and toddlers with unilateral cerebral palsy. The study will provide an overview of emerging research in CIMT that is critical for providing evidence-based practice.
Primary Author and Speaker: Casey Walker
Contributing Authors: Danielle Lowinger, Sara Rezak
PURPOSE: Cerebral Palsy (CP) is the leading cause of motor disability in childhood. Unilateral cerebral palsy is defined by motor impairments to one side of the body causing limited reach, grasp, and manipulation in the affected limb. These motor impairments cause a decrease in occupational participation and creates challenges in young children. Early intervention for infants and toddlers with unilateral CP has the potential to decrease functional deficits, improve overall motor performance, and increase participation in daily activities. Constraint induced movement therapy (CIMT) involves restraining the unaffected limb while implementing intense, therapeutic activities with the affected limb. CIMT has been shown to improve participation and functional performance in everyday activities of children (Ramey et al, 2013). Recent studies have been looking into the effectiveness of CIMT as a treatment for infants and toddlers with unilateral CP. Significant improvements in motor function, everyday tasks, and manual ability have been demonstrated (Horare et al, 2019). This scoping review investigates the effectiveness of CIMT in infants and toddlers with unilateral CP. The aim was to identify current evidence for CIMT protocols, gaps in research, and clinical applications for occupational therapy practice
DESIGN AND METHOD: This scoping review followed the methodical framework by Arksey and O'Malley (2005). Searching through selected databases (PubMed, PsychInfo, Cochrane, and CINAHL) and hand searching for additional studies, articles were independently reviewed by two authors to meet defined inclusion criteria.
RESULTS: A total of 10 studies were selected for review. Children that received CIMT displayed gains in functional and bimanual performance. Major themes identified from the data were: variation in CIMT protocols, feasibility of treatment, care giver education, and treating the child in their natural environment.
DISCUSSION AND CONCLUSION: Infants and toddlers that received CIMT displayed improvements in functional activities, bimanual integration, grasp patterns, and participation in daily occupations. Gains from CIMT intervention were maintained when follow-ups were conducted. Large protocol variations existed among studies in terms of dosage, intensity, type of restraint, and primary outcome measures used. Young children demonstrated high compliance and feasibility of CIMT conducted at such a young age. There was good tolerance to restraints applied to the unaffected limb, and no serious adverse consequences directly related to the restraint. Conducting treatment sessions in the child's natural environment (home, pre-school, or daycare) along with caregiver education in treatment delivery was a critical aspect of CIMT protocols. Occupational therapists should consider the child's current functional performance and abilities when selecting therapeutic activities (Eliasson et al., 2011). Intervention plans should be individualized to each client and adjusted to a just right level. Future research is needed to understand the effects of different dosages and repeated trials of CIMT starting from a young age.
IMPACT STATEMENT: CIMT engages children in rewarding, everyday occupations while helping overcome developmental delays by gaining and refining motor skills. This review allows practitioners to be aware of emerging research in CIMT to help provide evidence based practice.
References
Arksey, H., & O'Malley, L.A. (2005). Scoping studies: Towards a methodological framework. International Journal of Social Research Methodology, 8(1), 19–32. https://doi.org/10.1080/1364557032000119616
Eliasson, A.-C., Shaw, K., Berg, E., & Krumlinde-Sundholm, L. (2011). An ecological approach of Constraint Induced Movement Therapy for 2–3-year-old children: A randomized control trial. Research in Developmental Disabilities, 32(6), 2820–2828. https://doi.org/10.1016/j.ridd.2011.05.024
Hoare, B. J., Wallen, M. A., Thorley, M. N., Jackman, M. L., Carey, L. M., & Imms, C. (2019). Constraint-induced movement therapy in children with unilateral cerebral palsy. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.cd004149.pub3
Ramey, S. L., Coker-Bolt, P., & DeLuca, S. (2013). Handbook of pediatric constraint-induced movement therapy (Cimt): a guide for occupational therapy and health care clinicians, researchers, and educators. AOTA Press.
