Date Presented 03/22/24
This study describes the current landscape of constraint-induced movement therapy (CIMT) in the United States, with a focus on identifying barriers to its broader implementation to increase access to this underutilized intervention.
Primary Author and Speaker: Sophia Larson
Contributing Authors: Hunter Moore, Alyssa Smith, Bhooma Aravamuthan, Sharon Ramey, Catherine Hoyt
INTRODUCTION: Hemiplegic Cerebral Palsy (HCP) is the most common form of motor disability in children, characterized by unilateral motor weakness, (Dunbar et al., 2020). Constraint-Induced Movement Therapy (CIMT) is an evidence-based intervention that improves functional use of the affected upper extremity during high-intensity therapy. Despite its benefits, CIMT faces limited integration into clinical pediatric rehabilitation. The current study assessed perceived barriers to its implementation.
METHOD: Participants included professionals specializing in pediatric stroke or hemiplegic cerebral palsy. The Exploration-Preparation-Implementation-Sustainment model guided the research and design, (Moullin et al., 2019). Measures included the Interest and Implementation Survey (IIS) to assess familiarity with CIMT and the Implementation Climate Scale, (ICS; Ehrhart et al., 2014), to gauge organizational support for evidence-based practices. Surveys were distributed via email and summarized with descriptive statistics.
RESULTS: As of November 2023, 109 consented, and 76 completed the IIS. Seven occupational therapists and 14 physical therapists responded. Responses indicated high-level competency related to CIMT. While 87% of participants indicated CIMT availability, 57% reported that CIMT is not available to all children who could benefit. Insurance was the most used payment model (83%). A removable splint or soft immobilizer were the primary types of constraint used. On the ISC, a majority indicated that their organization values evidence-based practice but lacks incentives for implementing evidence-based interventions (66%).
CONCLUSIONS: This study highlights barriers to widespread implementation of CIMT for HCP. Despite professional competency, accessibility challenges persist due to lack of incentives for evidence-based practices. Overcoming these barriers requires collaborative efforts to integrate CIMT effectively into pediatric rehabilitation.
References
Dunbar, M., Mineyko, A., Hill, M., Hodge, J., Floer, A., & Kirton, A. (2020). Population Based Birth Prevalence of Disease-Specific Perinatal Stroke. Pediatrics, 146(5). https://doi.org/10.1542/peds.2020-013201
Ehrhart, M. G., Aarons, G. A., & Farahnak, L. R. (2014). Assessing the organizational context for EBP implementation: the development and validity testing of the Implementation Climate Scale (ICS). Implementation Science, IS, 9, 157. https://doi.org/10.1186/s13012-014-0157-1
Moullin, J. C., Dickson, K. S., Stadnick, N. A., Rabin, B., & Aarons, G. A. (2019). Systematic review of the Exploration, Preparation, Implementation, Sustainment (EPIS) framework. Implementation Science, 14(1), 1. https://doi.org/10.1186/s13012-018-0842-6
