Date Presented 04/13/21
Children with unilateral cerebral palsy participating in repeat doses of pediatric constraint-induced movement therapy camp augmented with the Hocoma Armeo®Spring demonstrated significant improvements in hand function and bimanual performance for both doses and showed a generalized upward trend in hand function over time.
Primary Author and Speaker: Heather Roberts
Additional Authors and Speakers: Sara P. Johnston, David Plutschack
INTRODUCTION: Pediatric Constraint-Induced Movement Therapy (P-CIMT) is a widely-recognized, effective intervention that promotes bilateral coordination of the upper extremities (UE) in children with unilateral CP (Ramey et al., 2013; DeLuca et al., 2015). The dosage of CIMT and its effects play an important role in the functional improvement of the paretic limb for children with CP. Priorities for future research should further examine the long-term effects associated with the overall dose and repeat doses of CIMT on motor development for children with CP. Although CIMT is effective, there is a primary gap in the literature that suggest the need for repeat doses of CIMT of the same design among 1-year intervals in order to explore the dose-response relationship and identify the age in which a ceiling effect occurs (DeLuca et al., 2015; Eliasson et al., 2014). The aim of this study was to further analyze the improved hand function and bimanual performance of children with unilateral CP from repeat doses of an augmented, group-based P-CIMT camp.
STUDY PARTICIPANTS: In this single group clinical trial, a total of 11 children with unilateral CP (age range 5-15 years, 6 male, 5 female, MACS 1 = 2, MACS 2 = 8, and MACS 3 = 1) participated in two sessions of an annual P-CIMT camp. Participants were recruited using convenience sampling at a pediatric orthopedic hospital in Southwestern United States.
MATERIALS/METHODS: Each participant attended 10 days of camp where they received group-based training wearing a constraint for a total of 50 hours, and participated in bilateral, occupation-based activities for 10 hours (60 hours total per dose of intervention). In each camp session, participants also spent 30 minutes on the Hocoma Armeo® Spring. The camp protocol followed a training manual and utilized a 1:1 interventionist ratio from occupational therapists or trained interventionists. The Assisting Hand Assessment (AHA) was conducted at the pre, post and 6-month follow-up. The AHA scores were recorded to create a baseline and to provide comparison of hand function changes during bimanual activities.
RESULTS: The mean interval between treatment 1 and 2 was 564 days. Most children were MACS Level II (8). AHA mean score at baseline of the first treatment with a SD 55.93+-12.78, the AHA score post camp treatment 1 was 66.53 with SD +-12.85. Treatment 2 mean AHA score was 58.13 with SD +-12.8, and post 66.53.
CONCLUSION: Overall, there was significant bimanual functional improvement effect as determined by the AHA, indicating regardless of which camp session, scores improved from pre to post, F(1, 28) = 74.81, p < .001, η2 =.73. The test for interaction between session and time (AHA at pre and post) was not significant, p = .49, indicating there was no difference between dose 1 and dose 2 in how children changed in AHA score. There is some preliminary evidence that there may have been a carryover effect in AHA improvement from first time to repeated baseline; however, this was not statistically significant. The carryover effect demonstrates a generalized upward trend in improved hand function with repeat doses of group-based P-CIMT. Effects that diminished between treatment doses demonstrating a ‘wear-off effect' were reversed with repeated treatments.
IMPACT STATEMENT: This study demonstrates the improved hand function and bimanual performance from repeated doses of an augmented P-CIMT camp in children with unilateral CP. This research explores the dosage effect in P-CIMT protocol to further improve long-term effects in bimanual hand function among children with CP.
References
DeLuca, S. C., Ramey, S. L., Trucks, M. R., & Wallace, D. A. (2015). Multiple treatments of Pediatric Constraint-Induced Movement Theory (pCIMT): A clinical cohort study. American Journal of Occupational Therapy, 69(6), 1-9. https://doi.org/10.5014/ajot.2015.019323
Eliasson, A. C., Krumlinde-Sundholm, L., Gordon, A. M., Feys, H., Klingels, K., Aarts, P. B. M., Rameckers, E., Autti-Ramo, I., & Hoare, B. (2014). Guidelines for future research in constraint-induced movement therapy for children with unilateral cerebral palsy: An expert consensus. Developmental Medicine & Child Neurology, 56(2), 125-137. https://doi.org/10.1111/dmcn.12273
Ramey, S. L., Coker-Bolt, P., & DeLuca, S. C. (2013). Handbook of pediatric constraint-induced movement therapy (CIMT). American Occupational Therapy Association, Inc.
