Cleveland Clinic Children's Outcomes
Pediatric Therapy Services
Constraint-Induced Movement Therapy for Children with Hemiplegia or Brachial Plexus Injury
2019 - 2023
Constraint-induced movement therapy (CIMT) is an innovative, scientifically supported method of upper extremity rehabilitation for children with neuromotor impairments, such as hemiplegia from cerebral palsy or pediatric stroke. 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 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 are summarized below in logit-based AHA units.
CIMT Average Improvement in AHA Logits
2019 - 2023
AHA = Assisting Hand Assessment
Data indicates gains for patients in 2023, with a mean increase in logit based AHA units of 9. An increase in ≥4 AHA logits is considered to be clinically significant. Since 2019, 42 out of 43 patients demonstrated an increase in their logit scores and 40 out of 43 patients demonstrated a clinically significant change.
Constraint-Induced Movement Therapy Summer Camp
2019 - 2023
Constraint-Induced Movement Therapy (CIMT) Summer Camps were offered in 2022 but with Covid precautions in place. The 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. 25 children were involved in the CIMT/HABIT groups in 2019-2023.
In 2019-2023 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, 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 one 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 shoulder 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 chart below summarizes the outcomes for the CIMT summer camps.
CIMT / HABIT Summer Camp Outcomes
2019 - 2023 (N = 25)
Average Gain
| Year | N | Box and Blocks | Grip Strength | Should Flexion | Quadruped Weight Bearing | AHA |
|---|---|---|---|---|---|---|
| 2019 | 6 | 5.67 | 1.06 | 8.33 | 27.4 | 9.33 |
| 2020 | 0 | |||||
| 2021 | 6 | 5.17 | 1.35 | 5 | 0 | 6.83 |
| 2022 | 5 | 6 | 2.48 | 0 | 0 | 8 |
| 2023 | 8 | 3.38 | 3.49 | 1.38 | 7.5 | 7.88 |
| 2019-2023 Average | 25 | 5.055 | 2.095 | 3.6775 | 8.725 | 8.01 |
An increase in ≥4 AHA logits is considered to be clinically significant, and the average increase in logit score for CIMT/HABIT Summer program in 2019-2023 was 8.01. The zero for quadruped weight bearing indicates these participants began the group with maximum performance. The zero for shoulder flexion indicates the participants had full range of motion at the beginning of camp.
