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Pediatric Constraint-Induced Movement Therapy for a Young Child With Cerebral Palsy: Two Episodes of Care

SC DeLuca, PhD, is a Civitan Post-Doctoral Fellow at the University of Alabama at Birmingham. This work was performed to fulfill the requirements for her Master of Arts degree and was supported by the Civitan International Research Center and the University of Alabama at Birmingham.
K Echols, PT, PhD, PCS, is Adjunct Associate Professor of Physical Therapy and Director, Pediatric Neuromotor Research Clinic, Civitan International Research Center
SL Ramey, PhD, is Susan H Mayer Professor of Child and Family Studies, Georgetown University, and Director, CHERITH, Georgetown Center on Health and Education, Washington, DC
E Taub, PhD, is University Professor and Professor of Psychology, University of Alabama at Birmingham, and is the originator of constraint-induced movement therapy

Address all correspondence to Dr DeLuca at Civitan International Research Center, University of Alabama at Birmingham, 1530 3rd Ave S, Birmingham, AL 35294 (USA) (sdeluca{at}uab.edu)

Background and Purpose. This case report describes the use of "Pediatric Constraint-Induced Therapy (Pediatric CI Therapy)" given on 2 separate occasions for a young child with quadriparetic cerebral palsy. Case Description. The child was 15 months of age at the beginning of the first episode of care. She had previously received weekly physical therapy and occupational therapy for 11 months, but she had no functional use of her right upper extremity (UE), independently or in an assistive manner. She scored from 5 to 7 months below her chronological age on developmental assessments in gross motor, fine motor, and self-help skills. Intervention. Pediatric CI Therapy involved placement of a full-arm, bivalved cast on the child's less affected UE while providing 3 weeks of intensive intervention (6 hours a day) for the child's more affected UE (intervention 1). Therapy included activities that were goal oriented but broken down into progressively more challenging step-by-step tasks. Pediatric CI Therapy was administered again 5 months later to promote UE skills and independence (intervention 2). Outcomes. The child developed new behaviors throughout both interventions. During intervention 1, the child developed independent reach, grasp, release, weight bearing (positioned prone on elbows) of both UEs, gestures, self-feeding, sitting, and increased interactive play using both UEs. During intervention 2, she had increased independence and improved quality of UE movement, as supported by blinded clinical evaluations and parent ratings.

Key Words: Cerebral palsy • Constraint-induced movement therapy • Early intervention • Hemiparesis • Physical therapy

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