A repeat dose of pediatric constraint induced movement therapy (abstract)

Background and Objective(s): Pediatric Constraint-Induced Movement Therapy (P-CIMT) and Hand Arm Bimanual Therapy (HABIT) are two intensive therapeutic approaches that have consistently demonstrated the ability to help children with hemiparetic cerebral palsy (hCP) gain increased functional skills and movement (Novak et al.; 2013, Hoare et al.; 2019). Knowledge from repeated doses of P-CIMT is limited and it is unclear what effect multiple doses of P-CIMT has on children with hCP. In the consensus report, Eliasson et al. 2013, encouraged further research of repeated doses of P-CIMT with the same design. The aim of the study was to determine the efficacy of repeat doses of P-CIMT in children with hCP.

Study Design: Prospective case series

Study Participants & Setting: A total of 11 children with hCP (age range 5–15 years, 6 male, 5 female, MACS 1=2, MACS 2=8, and MACS 3=1) participated in P-CIMT camp between 2012 and 2019. CIMT camp consists of 10 days of group intervention including 50 hours of wearing a constraint while participating in repetitive, shaped activities and a transfer package including 10 hours of bimanual training. Participants were recruited from a pediatric orthopedic hospital in southwestern United States.

Materials/Methods: The annual P-CIMT camp was kept consistent with the utilization of both camp and training manuals, at least 1:1 interventionists, and the same leadership. The Assisting Hand Assessment (AHA), was conducted pre, post, and 6 months following P-CIMT camp. The AHA assessed baseline bimanual ability and changes of assisting hand usage during bimanual activities. A repeated measures ANOVA was used to examine how participants changed on the AHA during their first and second camp session.

Results: The mean interval between first and second treatments was 564 days. Most children were MACS Level 2 (8). AHA mean score at baseline of the first treatment 55.93 (SD 12.78), the AHA score post camp treatment 1 66.53 (SD 12.85). The second treatment mean AHA score 58.13 (SD 12.8), and post 66.53.

Conclusions/Significance

Overall, there was a significant bimanual functional improvement effect as determined by the AHA, in both dose 1 and dose 2 of P-CIMT. Scores improved from pre to post, F(1, 28) = 74.81. p<0.001, n2=0.73. The test for interaction between session and time (AHA pre 1 to AHA pre 2 and AHA post 1 to AHA post 2) was not significant, p=0.49, indicting there was not a difference between year 1 and 2 in how children changed in AHA score. However, the results demonstrate a trend toward a carryover effect between P-CIMT doses in AHA improvement; however, not statistically significant. This may be due to the mean time between the repeated doses was almost 18 months. Overall, the results demonstrate a wear-off effect 18 months post P-CIMT intervention that is reversed with repeated treatments. Future research may look further into this clinically important improvement and timing of repeat doses of P-CIMT.