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Does the use of Constraint-Induced Movement Therapy (CIMT) result in improved upper limb function for children with hemiplegic Cerebral Palsy?

Prepared by:

Sheri Montgomery, OTR/L, FAOTA University of Utah OTD Student

Date:

October, 2012

Review Date:

October, 2014

Clinical Question:

Does the use of Constraint-Induced Movement Therapy (CIMT) result in improved upper limb function for children with hemiplegic Cerebral Palsy?

Clinical Scenario:

Children with upper limb hemiplegia often experience decreased ability to participate effectively and efficiently in tasks and occupations requiring bilateral hand use, which may include climbing the monkey bars during play, fastening buttons while getting dressed, school activities such as opening a gym locker, or completing a standardized academic assessment using a keyboard.   

Historically, Occupational Therapists have used a variety of strategies to address the needs of their clients.  Traditional interventions used to address upper limb hemiplegia include participation in bilateral tasks, strengthening of the affected limb, fine motor skill reinforcement, Electrical Muscular Stimulation (EMS), and Neurodevelopmental Treatment (NDT) techniques.  Occupational Therapists have also implemented constraint-induced movement therapy programs as one type of intervention. This treatment intervention was first used with adult clients and since the late 1990s has been used increasingly with children. 

Evidence to support the use of constraint-induced movement therapy with children demonstrating upper limb hemiplegia has typically considered the use of CIMT in combination with medical interventions such as Botox, however we are interested to know whether children demonstrate improvements in hand and upper limb function when CIMT is used alone.   

Clinical Bottom Line:

Evidence suggests that constraint-induced movement therapy results in increased use of the affected limb, especially when paired with therapeutic interventions designed to increase control, strength, and functional use.  Children who wore the restraint for 3.5 hours per day demonstrated similar improvement to those who wore it for 10 hours. The greatest improvement in functional skills was observed when Constraint Induced Movement Therapy was paired with goal specific interventions. Further research is required to determine the optimal wearing protocols for CIMT

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