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The effects of constraint-induced movement therapy for a child less than one year of age
Patty Coker1, Carisa Lebkicher, Lauren Harris
1Department of Rehabilitation Sciences,Medical University of South Carolina, Charleston, SC, USA. cokerp@musc.edu
Insights
Modified constraint-induced movement therapy (mCIMT) effectively improved gross and fine motor skills in an infant with hemiplegic cerebral palsy. Early mCIMT intervention shows promise for enhancing motor development in young children.
Area of Science:
- Pediatrics
- Neurology
- Rehabilitation Medicine
Background:
- Hemiplegic cerebral palsy (CP) often presents motor deficits in infants.
- Early intervention is crucial for optimizing motor development in children with CP.
- Constraint-induced movement therapy (CIMT) is a therapeutic approach that encourages the use of an affected limb.
Observation:
- A single-subject ABAB design study evaluated a modified CIMT (mCIMT) in an infant under one year old with hemiplegic CP.
- The intervention involved constraining the non-affected limb for 1 hour daily for 30 days, combined with task-specific activities.
- Motor skills were assessed using the Peabody Developmental Motor Scale-2 (PDMS-2) and Gross Motor Fine Motor Measure-88 (GMFM-88), alongside videotape analysis.
Findings:
- The infant demonstrated significant clinical improvements in both gross and fine motor skills post-mCIMT.
- Standardized assessments and observational analysis confirmed enhanced motor behaviors and task completion at the child's chronological age.
- The child achieved age-appropriate developmental motor tasks despite pre-existing right-sided hemiparesis.
Implications:
- This case study supports the efficacy of mCIMT for infants diagnosed with hemiplegic CP.
- Results suggest that early mCIMT implementation, before learned non-use patterns emerge, may significantly benefit motor development.
- Future research should focus on determining the optimal age for initiating mCIMT in hemiplegic CP to maximize functional outcomes.
Abstract:
The aim of this single case study was to determine the effectiveness of a modified version of constraint-induced movement therapy (mCIMT) on a child less than one year of age with a diagnosis of hemiplegic cerebral palsy. A single-subject ABAB design with a 6-month follow-up evaluation used repeated measures of gross and fine motor skills to determine changes at each phase of the study. Measures included the Peabody Developmental Motor Scale-2 (PDMS-2), the Gross Motor Fine Motor Measure-88 (GMFM-88) and videotape analysis of specific motor skills typically seen in children less than one year of age. The child in this study participated in a conventional occupational and physical therapy for 2 hours a week during the 2 baseline phases, A1 and A2, and mCIMT during the 2 intervention phases, B1 and B2. The mCIMT involved constraint of the non-affected limb for 1-hour a day for 30 consecutive days as the child was engaged in developmentally appropriate, task specific activities implemented by therapists and parents. Following participation in this mCIMT, the child demonstrated clinical improvements in both gross and fine motor skills as measured by standardized assessments and videotape analysis of motor behaviors. He was completing developmental motor tasks at his chronological age despite motor deficits resulting from a right-sided hemiparesis. The results of this study supports the use of mCIMT for children less than one year of age and could shift the focus of future research studies to determining the age in which to implement mCIMT before patterns of learned non-use begin to affect the normal development of skilled motor movements in children with hemiplegic CP.
