Research Article
Issue Date: September/October 2020
Published Online: August 03, 2020
Updated: August 07, 2020
Accelerometer Measurements Indicate That Arm Movements of Children With Cerebral Palsy Do Not Increase After Constraint-Induced Movement Therapy (CIMT)
Author Affiliations
  • Brianna M. Goodwin, MS, is Research Engineer, Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN. At the time of the research, she was Graduate Student, Department of Mechanical Engineering, University of Washington, Seattle, and Clinical Research Assistant, Rehabilitation Medicine, Seattle Children’s Hospital, Seattle, WA.
  • Emily K. Sabelhaus, MS, OTR/L, is Occupational Therapist, Rehabilitation Medicine, Seattle Children’s Hospital, Seattle, WA, and Pediatric Occupational Therapist, Whatcom Center for Early Learning, Bellingham, WA.
  • Ying-Chun Pan, BS, is Graduate Student, Department of Biomedical Engineering, University of Michigan, Ann Arbor. At the time of the research, he was Undergraduate Student, Department of Bioengineering, University of Washington, Seattle, and Clinical Research Assistant, Rehabilitation Medicine, Seattle Children’s Hospital, Seattle, WA.
  • Kristie F. Bjornson, PT, PhD, is Associate Professor of Pediatrics, Department of Pediatrics, University of Washington, Seattle.
  • Kelly L. D. Pham, MD, is Assistant Professor, Department of Physical Medicine and Rehabilitation Medicine, University of Washington, Seattle, and Assistant Professor, Seattle Children’s Hospital, Seattle, WA.
  • William O. Walker, Jr., MD, is Robert Aldrich Endowed Professor, Department of Pediatrics, University of Washington School of Medicine, Seattle.
  • Katherine M. Steele, PhD, is Albert S. Kobayashi Endowed Professor, Department of Mechanical Engineering, University of Washington, Seattle; kmsteele@uw.edu
Article Information
Hand and Upper Extremity / Neurologic Conditions / Pediatric Evaluation and Intervention / Research Articles
Research Article   |   August 03, 2020
Accelerometer Measurements Indicate That Arm Movements of Children With Cerebral Palsy Do Not Increase After Constraint-Induced Movement Therapy (CIMT)
American Journal of Occupational Therapy, August 2020, Vol. 74, 7405205100. https://doi.org/10.5014/ajot.2020.040246
American Journal of Occupational Therapy, August 2020, Vol. 74, 7405205100. https://doi.org/10.5014/ajot.2020.040246
Abstract

Importance: Constraint-induced movement therapy (CIMT) is a common treatment for children with unilateral cerebral palsy (CP). Although clinic-based assessments have demonstrated improvements in arm function after CIMT, whether these changes are translated and sustained outside of a clinic setting remains unclear.

Objective: Accelerometers were used to quantify arm movement for children with CP 1 wk before, during, and 4 wk or more after CIMT; measurements were compared with those from typically developing (TD) peers.

Design: Observational.

Setting: Tertiary hospital and community.

Participants: Seven children with CP (5 boys, 2 girls; average [AVE] age ± standard deviation [SD] = 7.4 ± 1.2 yr) and 7 TD peers (2 boys, 5 girls; AVE age ± SD = 7.0 ± 2.3 yr).

Intervention: 30-hr CIMT protocol.

Outcomes and Measures: Use ratio, magnitude ratio, and bilateral magnitude were calculated from the accelerometer data. Clinical measures were administered before and after CIMT, and parent surveys assessed parent and child perceptions of wearing accelerometers.

Results: During CIMT, the frequency and magnitude of paretic arm use among children with CP increased in the clinic and in daily life. After CIMT, although clinical scores showed sustained improvement, the children’s accelerometry data reverted to baseline values. Children and parents in both cohorts had positive perceptions of accelerometer use.

Conclusions and Relevance: The lack of sustained improvement in accelerometry metrics after CIMT suggests that therapy gains did not translate to increased movement outside the clinic. Additional therapy may be needed to help transfer gains outside the clinic.

What This Article Adds: Accelerometer measurements were effective at monitoring arm movement outside of the clinic during CIMT and suggested that additional interventions may be needed after CIMT to sustain benefits.