Efficacy of Constraint-Induced Movement Therapy Intervention for Children with Cerebral PalsyAndria Vetsch, Dr. Jane Case-SmithUniversity of Wisconsin-River Falls

The Ohio State University, College of Medicine, Occupational Therapy Division

ResultsBackground

MethodsDiscussion

Conclusion

References

Acknowledgments

1) Assess the consistency in which therapists administer CIMT in a pediatric hospital outpatient setting

2) Assess inter-rater reliability of the fidelity measure used to score these consistencies

3) Evaluate the effects of CIMT on a cohort of

children with hemiparetic CP

• Cerebral palsy (CP) is a chronic condition that affects body movements and muscle coordination.

• Spastic Hemiplegic is a type of CP that affects the function of one side of the body, typically the arm.

• Constraint-induced movement therapy (CIMT) is emerging as a treatment approach for children with hemiplegic cerebral palsy.

• CIMT is used to reduce impairment and improve functional use of the affected upper limb.

Features of CIMT

• Forced use of the involved upper extremity• Constraint of the non-affected arm• Intensive treatment (occupational therapy)• Education of parents

Purpose

• 20 minutes video recordings were taken throughout the intervention weeks which were later scored using the fidelity measure.

• Three raters scored four different CIMT sessions and each video contained different children and therapists.

• Pre-Post test data was collected from participants of CIMT at Nationwide Children’s Hospital (NCH).

I would like to thank SROP at Ohio State and The University of Wisconsin-River Falls McNair Scholars Program for giving me the opportunity to experience undergraduate research. In addition, I would also like to thank Dr. Jane Case-Smith and Dr. Alison Lane for their guidance and support throughout this project.

Therapist Rating (1-3)

Description of activity or action

Consistently (3)

Sometimes (2)

Seldom or not at all (1)

Mean rating

Clear goal 100% 3.00Age appropriate 100% 3.00Provided choices 50% 25% 25% 2.25Explicit instruction 75% 25% 2.75Explicit feedback 100% 2.00General praise 100% 3.00Extended practice 25% 75% 1.25Adapted activity 100% 2.00

Encouraged transfer of skills 50% 50% 1.50Promoted achievement 100% 3.00Required repetition 100% 3.00

Child rating(1-3)

Child's Response to intervention

Consistently (3)

Sometimes(2)

Seldom or not at all(1)

Mean rating

Engaged 75% 25% 2.75

Attempted new skill 25% 50% 25% 2.00

Repeated an action 75% 25% 2.75

Transferred a new skill 50% .500Exhibited full or partial performance 75% 25% 2.75

The tables present the percentage for the therapists’ consistency in implementing a theory-based treatment protocol.

1) The results show that the therapist were being 100% consistent in 5 activities. However, they rarely performed other actions (e.g. encouraging extended practice of targeted movement , encouraged transfer of skill to a variety of tasks/setting).

2) Inter-rater reliability was fair to excellent; correlations ranged from r= 0.50 to 0.95. The reliability for the fidelity items measuring therapist consistency was higher than reliability for the items rating child participation. 3) The CIMT participants made significant improvements in self-care, mobility and overall functional use of their affected limbs.

• Consistency throughout treatment will lead to

improved efficacy of therapy.

• Extended practice and encouraging transfer of skill helps to generalize skills in a variety of settings. Ratings for these two items should be increased.

• Developing a fidelity measure for CIMT and tracking child outcomes will lead to improved practices and optimal effects for children with cerebral palsy.

DeLuca SC, Echols K, Law CR, Ramey SL. Intensive pediatric constraint-induced therapy for children with cerebral palsy. J Child Neuro. 2006; 21: 931-938.

Taub E, Ramsey SL, DeLuca SC, Echols K. Efficacy of constraint-induced movement therapy for children with cerebral palsy with asymmetric motor impairment. Pediatrics 2004;113:305-312.

Mean Fidelity RatingRater Mean rating for

TherapistMean rating for child

1 2.43 2.002 2.07 2.253 2.14 1.69

Mean scores for Pre-Post test

The graph represents the pre-post test scores of six females and four males that participated in the CIMT program at Nationwide Children’s Hospital. Four had left affected limbs and six had right affected limbs (mean age: 3 years).