One Hand or Two for Children with Hemiplegia?: Effectiveness of Constraint Induced Movement Therapy (CIMT) Pat Burtner, PhD, OTR/L Department of Pediatrics, Division of Occupational Therapy John Phillips MD, Arvind Caprihan PhD Collaborators, MIND Institute Constraint of Non Hemiplegic Hand Massed Practice Hemiplegic Hand (Play, Self Care) Intensive 2 week Intervention 4 hours /day Impacting Developmental Disuse of Involved Extremity

Study 1: Effects of CIMT on Hand Function & Functional Skills (n=1) Time CIMT fMR I Pre Immediate Post 1 3 Months Post 2 Grip Changes Self Care Changes Parent Identified Goals

Study 2: Effects of CIMT Underlying Neural Mechanisms, Hand & Functional Skills (n=9) Significant ↑ Grip, Pinch ↓Timed Dexterity Significant ↑ EMG recruitment in Grip Significant ↓ EMG recruitment Timed Dexterity Preliminary analysis has revealed a possible relationship between of changes In Diffuse Tensor Imaging (DTI) Region of Interest and Grip Strength changes in 3 children receiving CIMT

Study 3: Effects of Multiple Doses of CIMT on Hand Function and Functional Skills (n=1) 3 years 5 years 8 years Measures Constant Research Design Constant Subject Constant Data Analysis In Progress

Study 4: Effect of Feedback on Motor Learning in Adults and Children (n=40) Katherine Sullivan PhD, PT, Collaborator Department of Biokinesiology and Physical Therapy, U.Southern California Adult Child EarlyLate Practice Adult (■) vs. Child (▲): 100% (solid) vs. 62% (open) Feedback on Acquisition & Retention

Study 5: Effect of Feedback on Motor Learning in Children with Hemiplegia (n=40) Katherine Sullivan PhD, PT, Collaborator Department of Biokinesiology and Physical Therapy, University of Southern California 20 Children with Hemiplegic Cerebral Palsy (Use Non Hemiplegic Dominant Hand) 20 Control Children (Use Dominant Hand) 100% Feedback on all Trials 1.Hope to establish best practice effects for children with cerebral palsy learning new motor skills 2. Considering use of MRI brain lesion analysis with subjects w/ CP to further understand cortical contributions to motor learning