EFFICACY OF CONSTRAINT-INDUCED MOVEMENT THERAPY INTERVENTION FOR CHILDREN WITH CEREBRAL PALSY Andria Vetsch Mentor: Dr. Jane Case-Smith The Ohio State University, Occupational Therapy Division and University of Wisconsin-River Falls

Introduction  Cerebral Palsy(CP)  Spastic Hemiplegic CP  Constraint-Induced Movement Therapy(CIMT)  Features of CIMT  Constraint of the non-affected limb  Forced use of the involved upper extremity  Intensive treatment  Education of parents 4,5

Past Research  Improved hand-movement efficiency  Hands to midline  forearm supination and pronation  transferring a cube between hands  ulnar/palmer grasping with the hands  Investigated the protocol (length, frequency of treatment, populations participating)  Lack of research on fidelity of treatment 1,3,5 2

Purpose 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

Methods CIMT participants from NCH 10 childrenAge range: 10 months- 13years Mean age: 3 years6 females, 4 malesAffected limbs: 6 right, 4 left Pre-Post assessment scores were collected at Nationwide Children’s Hospital (NCH) Fidelity measure participants 4 childrenAge range: 21months-10years Mean age: 5 years3 females, 1 maleAffected limb: 4 right Video recordings were taken throughout treatment session and scored by three raters

Mean Score for Pre-Post Test Mean scores

Mean Fidelity Rating RaterMean rating for Therapist Mean rating for child

Conclusion  Pre-Post test scores improved  Consistency can lead to improved efficacy of therapy  Promote the development of new skills and help to generalize skills in a variety of settings  Developing a fidelity measure for CIMT and tracking child outcomes

Further Research  Continue to assess the administration of CIMT  Continue to research the effects of CIMT

Questions?  Thanks to SROP at Ohio State, Dr. Jane Case-Smith, and the University of Wisconsin River-Falls McNair Program for the opportunity to participate in this unique research project.

References 1.Case-Smith, J., and O’Brien,JC. Occupational Therapy for Children. 6th ed. Maryland Heights, MO: Mosby/Elsevier, (2010) Print. 2.DeLuca, Stephanie C., Karen Echols, Charles R. Law, and Sharon L. Ramey. "Intensive Pediatric Constraint-Induced Therapy for Children With Cerebral Palsy: Randomized, Controlled, Crossover Trial." Journal of Child Neurology (2006): Print. 3.Deluca,SC,Echols,K,Ramey,SL, Taub,E. Pediatric constraint-induced movement therapy for a young child: tow episodes of care. Phy Ther. (2003): Print. 4. Gordon,Andrew M., Charles,Jeanne, Wolf, Steven L. " Methods of Constriant-Induced Therapy for Children with Hemiplegic Cerebral Palsy: Development of a Child-Friendly Intervention for Improving Upper-Extremity Function. " Phys. Med. Rehabilitaion 86(2005): Print. 5. Taub, Edward, Sharon Landesman Ramey, Stephanie DeLuca, and Karen Echols. "Efficacy of Constraint-Induced Movement Therapy for Children with Cerebral Palsy with Asymmetric Motor Impairment." Pediatrics (2004): Print.