Transcript One Hand or Two for Children with Hemiplegia

One Hand or Two for Children with Hemiplegia?:
Effectiveness of
Constraint Induced Movement Therapy (CIMT)
Pat Burtner, PhD, OTR/L
Department of Pediatrics, Division of Occupational Therapy
John Phillips MD, Arvind Caprihan PhD
Collaborators, MIND Institute
Constraint of Non
Hemiplegic Hand
Massed Practice
Hemiplegic Hand
(Play, Self Care)
Intensive 2 week
Intervention
4 hours /day
Impacting
Developmental
Disuse of Involved
Extremity
Study 1: Effects of CIMT on Hand Function
& Functional Skills (n=1)
Immediate
Post 1
Pre
3 Months
Post 2
Self Care Changes
Changs in PEDI Self-Care Domain
70
60
50
40
Score
Toileting
Time
fMR
I
CIMT
Dressing
Grooming
Feeding
30
20
fMR
I
10
0
A1
Grip Changes
A2
A3
Parent Identified Goals
Changes in COPM Performance & Satisfaction
10
Changes in Grip Strength
9
12.0
8
10.0
7
6
Right
Hand
Left
Hand
6.0
Score
Pounds
8.0
Baseline
5
Post Test 1
Post Test 2
4
3
4.0
2
2.0
1
0
0.0
A1 (2 weeks)
Intervention
(2 weeks)
A2 (2 weeks)
12 weeks
A3 (2 weeks)
Performance
Satisfaction
Parent Identified Goals
Study 2: Effects of CIMT Underlying Neural
Mechanisms, Hand & Functional Skills (n=9)
Significant
↑ Grip, Pinch
↓Timed Dexterity
Significant ↑
EMG recruitment
in Grip
Significant ↓
EMG recruitment
Timed Dexterity
How are Motor Pathways Different in Children
with Congenital Hemiplegia?
Schizencephaly
Preliminary analysis has revealed a
possible relationship between of changes
In Diffuse Tensor Imaging (DTI) Region
of Interest and Grip Strength changes in
3 children receiving CIMT
Study 3: Effects of Multiple Doses of CIMT on
Hand Function and Functional Skills (n=1)
3 years
5 years
8 years
Subject
Constant
Research
Design
Constant
Data Analysis
In
Progress
Measures
Constant
Study 4: Effect of Feedback on Motor
Learning in Adults and Children (n=40)
Katherine Sullivan PhD, PT, Collaborator
Department of Biokinesiology and Physical Therapy, U.Southern California
Early
140
100
100
50
50
Arm angular
position
0
500
1000
1500
0
140
140
100
100
50
50
0
0
500
1000
1500
0
Adult
0
500
1000
1500
Child
0
500
1000
1500
Adult (■) vs. Child (▲):
100% (solid) vs. 62% (open) Feedback
on Acquisition & Retention
25
20
RMSE
0
Lever
Late Practice
140
15
10
100 %
62%
feedback groups
Study 5: Effect of Feedback on Motor
Learning in Children with Hemiplegia (n=40)
Katherine Sullivan PhD, PT, Collaborator
Department of Biokinesiology and Physical Therapy, University of Southern California
Lever
Arm angular
position
20 Children with Hemiplegic Cerebral Palsy
(Use Non Hemiplegic Dominant Hand)
20 Control Children
(Use Dominant Hand)
100% Feedback on all Trials
1. Hope to establish best practice effects for
children with cerebral palsy learning new motor skills
2. Considering use of MRI brain lesion analysis with
subjects w/ CP to further understand cortical
contributions to motor learning