Pediatric Therapy Services

Constraint-Induced Movement Therapy

Constraint-Induced Movement Therapy: Average Improvement in AHA Logits

2017 - 2019

Constraint-induced movement therapy (CIMT) is an innovative, scientifically supported method of upper extremity rehabilitation for children with neuromotor impairments often used to treat children with hemiplegia. CIMT involves constraint/casting of the non-affected upper extremity in combination with intensive therapy. Therapy consists of three weeks of intensive outpatient occupational therapy services for five days per week, three hours per day.

Pre- and post assessments are performed using the Assisting Hand Assessment (AHA). The AHA measures how effectively children with unilateral hand dysfunction use their involved hand collaboratively with their well-functioning hand to perform bimanual tasks. The logit-based 0-100 AHA-unit scale was used to obtain this data. Treatment courses and outcomes for these patients are summarized below in logit-based AHA units.

AHA = Assisting Hand Assessment

Data indicates gains for patients in 2019, with a mean increase in logit-based AHA units of 9.10. An increase of ≥4 AHA logits is considered to be clinically significant. All 10 patients demonstrated an increase in their logit scores, and 9 of the 10 participants demonstrated a clinically significant change.

Constraint-Induced Movement Therapy Summer Camp

2017 - 2019

In 2019, Therapy Services offered two camps for children based on the Constraint Induced Movement Therapy (CIMT) protocol. Both groups followed the CIMT protocol for one week followed by two weeks of the Hand Arm Bimanual Intensive Therapy (HABIT) protocol. Children in the CIMT/HABIT group participated for 3 hours a day, 5 days a week for 3 weeks, totaling 45 treatment hours. Children in this group wore casts on their unaffected side for one week to promote increased use of their affected side; the cast was removed after the first week and was followed by 2 weeks of bimanual and ADL training. Children participating in these groups included those with cerebral palsy and pediatric stroke who had previously received individual CIMT treatment. A total of six children were involved in the CIMT/HABIT groups in 2019.

In 2019, pre- and post assessments were completed for all children, which included the following tests: box and blocks test, grip strength, active range of motion for shoulder flexion, quadruped weight bearing, and the Assisting Hand Assessment (AHA). The box and blocks test was used to assess how many blocks the children could move in 1 minute, 1 at a time, from 1 side of a partitioned box to the other side using their affected limb. Grip strength was measured in pounds of pressure using a dynamo-meter. Active range of motion was measured in degrees of movement using a goniometer. Quadruped weight bearing was measured in seconds. The AHA is a criterion-referenced assessment that measures how effectively the affected hand and arm is used in bi-manual performance. The graphs below summarize the outcomes for the CIMT summer camps.

Year/Sample SizeAverage Gain in Box and Blocks (No. of Blocks)Average Gain in Grip Strength (PSI)Average Gain in Shoulder Flexion (Active ROM, Degrees)Average Gain in Quadruped Weight-Bearing (Seconds)AHA

2017

N = 11

4.11.511.724.76.4

2018

N = 7

9.12.26.95.114.6

2019

N = 6

5.71.18.327.49.3

3-year Avg

N = 24

6.12.19.520.29.5

PSI = pounds per square inch, ROM = range of motion

An increase of ≥4 AHA logits is considered to be clinically significant, and the average increase in logit score for this program in 2019 was 9.5 logits.