Posted on February 2, 2004 at 1:15 p.m.
BIRMINGHAM, AL — A form of physical therapy developed by UAB (University of Alabama at Birmingham) researchers for rehabilitation of stroke patients can also help children with certain kinds of cerebral palsy (CP), according to a new study published in the February issue of Pediatrics. The study authors found that children with CP-induced hemiparesis demonstrated significant improvement in motor function after Constraint-Induced Movement therapy (CI therapy).
“Some children with CP have a substantially greater motor defect in one extremity than the other — a condition known as hemiparesis, also common in adults following stroke or traumatic brain injury,” says Edward Taub, Ph.D., professor of psychology at UAB and the founder of CI therapy. “Since we have shown CI therapy to be very effective in helping adults regain motor function following stroke, it was natural to examine whether similar results could be attained in children with hemiparesis.”
CI therapy involves restraining the stronger, less-affected extremity and training the patient to use the weaker, more-affected arm or leg for many hours a day over a period of consecutive weeks. The benefits of CI therapy for stroke patients are well documented and use of the therapy is increasing worldwide.
The research team, based at the UAB Sparks Center for Developmental and Learning Disorders, included Karen Echols, Ph.D., Stephanie DeLuca, Ph.D. and Sharon Ramey, Ph.D. They studied 18 children under the age of eight with hemiparesis due to CP. A control group of nine children received conventional treatment. The other nine received a modified form of CI therapy known as Pediatric CI therapy for 6 hours a day for 21 days.
Their stronger arm was restrained with a lightweight fiberglass cast and therapists led the children in play activities with a variety of physical tasks such as reaching, grasping, bearing weight on their arm, and making hand gestures.
The team found that Pediatric CI therapy in children with cerebral palsy-induced hemiparesis produced major and sustained improvement in motor function in the weaker limb.
“Pediatric CI therapy produced a large improvement in the use of the more-affected extremity, at least as great as that obtained with adults,” Taub says. Many of the children exhibited new motor behaviors and patterns of functional behavior that had not been observed before the therapy period, such as children who began crawling following treatment and two children who began to sit up independently.
“The improvements were sustained through follow-up testing six months following therapy,” said DeLuca, one of the study co-authors. “Therapists and parents reported supplemental evidence of beneficial quality of life changes for many children. One boy who had not previously used his more-affected arm began to play baseball and go fishing with his father.”
As is also the case with adult CI therapy, Taub says the current findings indicate that more intensive delivery of pediatric rehabilitation services than is conventionally given can produce large, sustainable gains.
Grant support for this research was provided by the Alabama Health Services Foundation, the Civitan International Research Center, the National Institute of Child Health and Human Development of the National Institutes of Health, the Administration of Developmental Disabilities and the Maternal and Child Health Bureau.