Emily Christman, Kaitlin McAllister, Katie Claar, Samantha Kaufman, Stephen J. Page; Occupational Therapists’ Opinions of Two Pediatric Constraint-Induced Movement Therapy Protocols. Am J Occup Ther 2015;69(6):6906180020. https://doi.org/10.5014/ajot.2015.019042
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© 2020 American Occupational Therapy Association
OBJECTIVE. We sought to determine occupational therapists’ opinions of two pediatric constraint-induced movement therapy (pCIMT) protocols.
METHOD. A total of 272 therapists in pediatric rehabilitation clinics completed an electronic survey to determine their opinions of two published pCIMT protocols. In Protocol A, restraint is worn 24 hr/day on the nonparetic upper extremity (UE), and in-clinic, therapist-supervised practice sessions occur 7 days/wk for 6 hr/day over 3 wk. In Protocol B, restraint is worn 2 hr/day on the nonparetic UE, and in-clinic, therapist-supervised practice sessions occur 1 day/wk for 2 hr/day over 8 wk.
RESULTS. The majority of participants reported moderate to high concerns about every facet of Protocol A. Conversely, >50% of participants reported low or no concerns about five of seven facets of Protocol B.
CONCLUSION. This study adds to a growing body of evidence suggesting that therapists strongly prefer low-duration pCIMT protocols.
Constraint-induced movement therapy (CIMT) is a new treatment for use with children with hemiplegic cerebral palsy. The main components of CIMT include restraining the unaffected limb and using repetition and structured activity to improve the function of the affected limb. Modifications have been made to the typical CIMT protocol by requiring less time in constraint and therapy. Initial research indicates that both protocols described below improve the use and function of the affected arm. Please note: You do not have to have prior experience with CIMT to participate. We are interested in your professional opinions regarding the feasibility of implementing either of the following two protocols in your clinical environment with the children and families you see.
Length of time child has to wear cast on functioning arm, either 24 hr/day for 3 wk (Protocol A) or 2 hr/day for 8 wk (Protocol B)
Ability to provide occupational therapy services either 7 days/wk for 6 hr/day (Protocol A) or 1 day/wk for 2 hr (Protocol B)
Expectation of third-party reimbursement or ability to fund therapy time and materials
Safety of child when wearing constraint (full-arm fiberglass cast)
Child’s frustration level during performance of daily tasks
Child’s ability to participate in therapy 6 hr/day, 7 days/wk (Protocol A) or in caregiver-led activities 2 hr/day, 6 days/wk (Protocol B)
Caregiver’s or family’s ability to adhere to protocol.
The majority of occupational therapists prefer shorter pCIMT protocols.
Most occupational therapists have moderate to severe concern with protocols lasting multiple days per week and that have moderate to high durations of several hours per day. Most of these therapists also reported that it is unlikely to highly unlikely that such protocols would be reimbursed under existing managed care rules and that clients would fully comply with the protocol parameters.
In adult populations, modified CIMT protocols are available on an outpatient basis and are efficacious. Given this finding in adult populations, pCIMT constitutes an area ripe for future investigation.
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