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Repeated episodes of pediatric constraint induced movement therapy with a gross motor training component: A
Kathy Grinde1, Jayne Myhre1, Michael D Finch2
1Children's Minnesota-Maple Grove, Physical Medicine and Rehabilitation, Maple Grove, MN, USA.
Insights
Pediatric constraint-induced movement therapy (PCIMT) combined with gross motor training (GMT) improved motor skills and daily function in children with upper extremity impairment. Repeated therapy sessions led to further gains.
Area of Science:
- Pediatric rehabilitation
- Neurorehabilitation
- Occupational therapy
Background:
- Unilateral upper extremity impairment affects children's motor development and daily participation.
- Constraint-Induced Movement Therapy (CIMT) is effective, but pediatric adaptations (PCIMT) are crucial.
- Combining PCIMT with Gross Motor Training (GMT) may enhance outcomes.
Purpose of the Study:
- To evaluate the effectiveness of repeated 21-day episodes of pediatric constraint-induced movement therapy (PCIMT) combined with gross motor training (GMT).
- To assess the impact of multiple PCIMT-GMT cycles on motor function and participation in children with unilateral upper extremity impairment.
Main Methods:
- A cohort study involving 19 children (14 months - 6 years) with unilateral upper extremity impairment.
- Participants underwent repeated 21-day cycles of PCIMT-GMT.
- Outcome measures included the Peabody Developmental Motor Scales-2 (PDMS-2), Assisting Hand Assessment (AHA), and Canadian Occupational Performance Measure (COPM).
Main Results:
- All children showed raw score improvements after each PCIMT-GMT episode.
- Statistically significant improvements were observed in most measures, with gains on the AHA and COPM exceeding minimal detectable and clinically meaningful thresholds, respectively.
- Repeated episodes consistently led to further improvements in motor skills and functional performance.
Conclusions:
- PCIMT-GMT effectively improves fine motor, gross motor, and bimanual skills in children with unilateral upper extremity impairment.
- Functional participation in daily activities is enhanced through this combined therapy approach.
- Repeated cycles of PCIMT-GMT can lead to cumulative and sustained improvements in pediatric rehabilitation.
Purpose:
To examine the results of repeated episodes of 21-day pediatric constraint induced movement therapy (PCIMT) paired with gross motor training (GMT).
Methods:
Nineteen children, age 14 months - 6 years with unilateral upper extremity impairment enrolled in this cohort study to receive repeated episodes of 21 day PCIMT-GMT. Outcome measures included the Peabody Developmental Motor Scales-2 (PDMS-2), the Assisting Hand Assessment (AHA) and the Canadian Occupational Performance Measure (COPM).
Results:
All children demonstrated improvement in raw scores following each episode of PCIMT-GMT with a statistically significant change in the least squares estimated mean for all measures except the PDMS-2 total motor raw score and gross motor quotient for the preferred hand in the fourth episode (p< 0.05). Gains were noted on the Scaled Score for the AHA for 39/39 episodes, all greater than the smallest detectable difference. COPM Performance and Satisfaction scores for 17/17 episodes were above the clinically meaningful threshold. Additional improvements in scores were noted in all children with each repeated episode.
Conclusion:
Children with unilateral upper extremity impairment demonstrate improvements in fine motor, gross motor, and bimanual skills, along with functional changes in participation in daily life, following PCIMT-GMT. Participation in repeated episodes can lead to further improvements.
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