Pediatric Therapy Services

Constraint-Induced Movement Therapy

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 nonaffected upper extremity in combination with intensive therapy. Therapy consists of 3 weeks of intensive outpatient occupational therapy for 5 days per week, 3 hours per day.

Pre- and post assessments include 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 is summarized below in logit-based AHA units.

Average Improvement in AHA Logits

2016 - 2018

AHA = Assisting Hand Assessment

Data indicate gains for patients in 2018, with a mean increase in logit-based AHA units of 8.2. An increase in ≥4 AHA logits is considered to be clinically significant. All 13 patients demonstrated an increase in their logit scores, and 12 of the 13 participants demonstrated a clinically significant change.

Constraint-Induced Movement Therapy Summer Camp

2016 - 2018

In 2018, Therapy Services, Cleveland 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 affected 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 seven children were involved in the CIMT/HABIT groups in 2018.

In 2018 pre and post measures were completed for all children, which included the box and blocks test, grip strength, active range of motion for shoulder flexion, and 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 dynamometer. 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 bimanual performance. The graphs below summarize the outcomes for the CIMT summer camps.

Year Average 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) AHAᵃ
2016 (N = 4) 0.8 5.5 4.0 70.0 8.8
2017 (N = 11) 4.1 1.5 11.7 24.7 6.4
2018 (N = 7) 9.1 2.2 6.9 5.1 14.6
3-year Average (N = 22) 5.1 2.5 9.3 26.7 9.4

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

ᵃMeasurement began in 2016

An increase in ≥4 AHA logits is considered to be clinically significant, and the average increase in logit score for this program in 2018 was 14.6 logits.