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Stroke and Transient Ischemic Attacks of the Brain and Eye
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Hand and arm function might be improved by constraint-induced movement therapy, frequent repetitive task practice, mental practice, mirror therapy, interventions for sensory impairment, and virtual reality, but the quality of the supporting evidence is only moderate and the results are not all favorable. Constraint-induced movement therapy involves constraining the nonparetic arm (e.g. wearing a mitt on the nonparetic hand) and undertaking graded task-oriented training of the paretic arm. Robot-assisted, task-orientated, and arm training devices could improve muscle strength and function in the paretic arm, but the quality of the evidence is low.
Physical and Cognitive Rehabilitation for Children with Brain and Spinal Tumors
Published in David A. Walker, Giorgio Perilongo, Roger E. Taylor, Ian F. Pollack, Brain and Spinal Tumors of Childhood, 2020
Alexandra M. Gaynor, Helen Hartley, Stephen A. Sands
An older systematic review on exercise physical therapy interventions for children with cerebral palsy56 reported limited evidence on most physical therapy interventions but did demonstrate effectiveness of upper-limb training. Occupational hand therapy treatment (in a mixed population of children with hemiplegia and quadriplegia57) and prehensile hand treatment in conjunction with neurodevelopmental treatment,58 again in a mixed population of children with hemiplegia and quadriplegia, were both reported to show upper-limb functional improvements. A high-quality study on constraint induced movement therapy (CIMT) in children with cerebral palsy demonstrated improved quality and amount of upper-limb movement.59 CIMT is based on the principle of repetitive practice positively influencing cortical reorganization. This may be particularly beneficial where there is a pattern of disuse of the affected side.60,61 Sparrow et al.62 reported a pilot study to investigate the feasibility of using CIMT in a sample of 9 children aged 2–12 years who had completed treatment of a brain tumor. They completed a 3-week program (3 hours per day, 5 days a week) and suggested that CIMT is feasible to use in children with brain tumors. Although parent feedback indicated the program was difficult, all reported satisfaction with the intervention, and as quality and amount of arm movement improved and this was maintained at 3-month follow-up.
Promoting hand skills
Published in Chia Swee Hong, Heidi Rumford, Alex Cole, Sensory Motor Activities for Early Development, 2020
Chia Swee Hong, Heidi Rumford, Alex Cole
Pediatric constraint-induced movement therapy (CIMT) is another approach. Its core elements are (Case-Smith and Exner 2015): hold the child’s less affected arm and handselect and grade activities to encourage movement of the more affected arm and hand provide intensive practice within the child’s environmentoffer praise and transfer practice to the child’s daily routine.For example, a 2-year-old child with cerebral palsy has increased tone in his upper shoulders and upper limbs. He may use a pattern of turning the shoulders gently inwards (internal rotation), turning his palm to face downwards (pronation) and fisting of his dominant hand to grasp and release a toy. A Bobath-trained practitioner may observe his head and trunk control and gently externally turn the shoulders outwards (rotation and abduction) and turn the palm of the hand upwards (supination). The child gradually learns active control of the arm in a functional position, and it is important for him to practise the movement in daily living activities. Carlsson (2002) gave an excellent description of the Bobath approach in the assessment and management of a child with cerebral palsy.
Constraint Induced Movement Therapy in Infants and Toddlers with Hemiplegic Cerebral Palsy: A Scoping Review
Published in Occupational Therapy In Health Care, 2022
Casey Walker, Angela Shierk, Heather Roberts
Constraint induced movement therapy (CIMT) involves restraining the unaffected upper limb while undergoing intensive, unimanual training with shaping of the affected limb. Therapeutic activities used while the unaffected limb is restrained targets developmental disregard in children with hemiplegic CP. The intended goal is to promote use of the affected limb during performance of functional activities (Hoare et al., 2019). Systemic reviews support the clinical effectiveness of CIMT for school aged children with hemiplegic CP (Burkhardt et al., 2017; Huang et al., 2009; Novak et al., 2020). Significant improvements were reported for outcomes measuring activity performance, self-care, body function, participation, and quality of life for children with hemiplegic CP throughout childhood. CIMT is considered an effective treatment for improving unimanual tasks such as reaching, grasping, and manipulating objects. Positive effects from CIMT were maintained at follow ups conducted at four weeks, eight weeks, and six months. There has also been emerging evidence focused on the effectiveness of CIMT specifically as a treatment for infants and toddlers with hemiplegic CP. Improvements have been demonstrated in overall gross motor function and functional everyday use of the affected limb in infants. Following baby-CIMT, there is an increased development of manual ability in the involved hand (Deluca et al., 2016; Eliasson et al., 2014).
How are children with cerebral palsy managed in public hospitals of KwaZulu-Natal, South Africa?
Published in Physiotherapy Theory and Practice, 2021
Sonill S. Maharaj, Tracey-Lee White, Bashir Kaka
The physiotherapists in this study support constraint-induced movement therapy being a treatment technique of minor importance, suggesting that other theories were more relevant. The value of constraint-induced movement therapy is predominantly for children with CP who are affected unilaterally like spastic hemiplegia which comprises (25%) of the CP population and to improve motor skills (Taub, Ramey, DeLuca, and Echols, 2004). It is possible that physiotherapists in KZN are not aware of the relevance of constraint-induced movement therapy. This may be due to their undergraduate training not including this or a lack of clinical practice guideline for rehabilitation of children with CP in poor resource setting like SA. It may also be due to other factors such as they are only taught specific treatment techniques or they treat a limited number of spastic hemiplegic children with CP.
The effects of modified constraint-induced movement therapy combined with intensive bimanual training in children with brachial plexus birth injury: a retrospective data base study
Published in Disability and Rehabilitation, 2021
Ingar M. Zielinski, Renske van Delft, Jeanine M. Voorman, Alexander C. H. Geurts, Bert Steenbergen, Pauline B. M. Aarts
During the first 6 weeks, the unaffected upper limb was restrained using a splint or a sling while at the same time providing intensive structured training for the affected upper limb (based on constraint-induced-movement-therapy principles) [34]. In this training, the principles of shaping and repetitive task practice were applied [31,34]. The total time of modified constraint-induced-movement-therapy was 54 h (6 weeks: 2 × 4.5 h or 6 weeks: 3 × 3 h). In the last 2–4 weeks bimanual activities were trained with special attention for specific goals set by the parents (bimanual training). During this period the children were encouraged to use both hands during typical bimanual activities and thus prompted to use the affected upper limb. The total time for this bimanual training was 18 h (2 weeks: 3 × 3 h or 4 weeks: 2 × 2 h).