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ConstraintInduced Therapy
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Tx group received CI therapy (bivalved cast and intensive behavioral training ... Results: CIT improved motor skills of involved arm on EBS, PMAL, TAUT measured ... – PowerPoint PPT presentation
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Title: ConstraintInduced Therapy
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Constraint-Induced Therapy
- Darcy Fehlings, MD, MSc, FRCPC
- Sophie Lam-Damji, BSc, OT
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Outline
- Constraint-Induced Therapy Definition
- Evidence from the literature
- Report of a Case Study
- ? Integration into Clinical Practise
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Constraint-Induced Therapy (CIT)
- Constraint of the less affected arm
- Intensive behavioral training for the affected
arm in individuals with hemiplegia
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CIT Lessons from the Adult Literature
- Case series and RCTs in adult stroke literature
support CIT (Taub 1993 Taub 1998 Kunkle 1999) - Dose effect demonstrated for the number of hours
of intensive behavioural training provided (Taub
2002)
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CIT Evidence in Pediatrics Willis et al.
Pediatrics 200211094
- RCT
- Constraint alone with arm cast x 1 month vs no
constraint - No intensive behavioral training
- Significant improvement in motor function
following constraint therapy (PDMS)
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Efficacy of Constraint-Induced Movement
TherapyTaub et al Pediatrics 2004 113 305-312
- RCT of 18 children with hemiplegic CP (age 7-96
months) - Tx group received CI therapy (bivalved cast and
intensive behavioral training 6hrs/day for 21
days - Results CIT improved motor skills of involved
arm on EBS, PMAL, TAUT measured at 3 weeks and
maintained at 6 months - Group will be reporting on cross-over trial in
near future
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Effects of Constraint-induced movementEliason
et al DMCN 2005, 47 266-275
- Controlled clinical trial (25 children in Tx, 20
in control) Dx hemiplegia age 18 mo to 4 yrs - Tx group- wore a constraint glove for 2 hours/day
over 2 months, paired with OT weekly and
parent/caregiver carry-over - Results significant impvt in the Tx group in
the AHA
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Modified Constraint...A pilot studyNaylor et al
DMCN 2005, 47 365-369
- Single-case experimental design using children as
their own controls - Assessments at baseline, 4,8 and 12 weeks
- Intervention between 4 and 8 weeks consisted of
2X weekly therapy (verbal instruction and gentle
restraint) - Significant impvt seen on QUEST
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Issues with Constraint
- Intensive Behavioral Therapy or tx to go with
constraint - Different types of Constraint (cast vs glove)
- Who will respond
- When to repeat
- Side Effects concerns re constraining good
arm, child tolerance of the constraint, risk of
falls
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