Retrospective Analysis of an Ongoing Group-Based Modified Constraint-Induced Movement Therapy Program for Children with Acquired Brain Injury

Abstract

ABSTRACT. Aim: A pretest–posttest retrospective design was used to evaluate the impact of a group-based modified constraint-induced movement therapy (mCIMT) program on upper extremity function and occupational performance. Methods: 20 children ages 3 to 18 years with hemiplegia following an acquired brain injury participated in a 2-week group mCIMT program. Upper extremity function was measured with the Assisting Hand Assessment (AHA) and subtests from the Quality of Upper Extremity Skills Test (QUEST). Occupational performance and satisfaction were assessed using the Canadian Occupational Performance Measure (COPM). Data were analyzed using a Wilcoxon signed-ranks test. Results: Group-based analysis revealed upper extremity function and occupational performance attained statistically significant improvements from pre- to postintervention on all outcome measures (AHA: Z = −3.63, p = <.001; QUEST Grasps: Z = −3.10, p = .002; QUEST Dissociated Movement: Z = −2.51, p = .012; COPM Performance: Z = −3.64, p = <.001; COPM Satisfaction: Z = −3.64, p = <.001). Across individuals, clinically significant improvements were found in 65% of participants’ AHA scores. 80% of COPM Performance scores and 70% of COPM Satisfaction scores demonstrated clinically significant improvements in at least one identified goal. Conclusions: This study is an initial step in evaluating and providing preliminary evidence supporting the effectiveness of a group-based mCIMT program for children with hemiplegia following an acquired brain injury.

KEYWORDS. :

• brain injury
• constraint-induced movement therapy
• occupational therapy
• pediatrics
• rehabilitation

ACKNOWLEDGMENTS

The authors would like to thank the participants and their families of the Helping Hand program at Holland Bloorview Kids Rehabilitation Hospital for their support and participation in this research.

Declaration of Interest: The authors report no conflict of interest and are responsible for the content and writing of this article.

FUNDING

Funding to support this study was provided by the Centre for Leadership in Acquired Brain Injury at Holland Bloorview Kids Rehabilitation Hospital. One of five Centres for Leadership at Holland Bloorview, the Centre for Leadership in Acquired Brain Injury provides funding and support to integrate clinical, research, and education initiatives specific to pediatric brain injury.

ABOUT THE AUTHORS

Alyssa Komar, Kelsey Ashley, Kelly Hanna, and Julia Lavallee were students of occupational therapy (MScOT) within the Department of Occupational Science and Occupational Therapy at the University of Toronto during the completion of this study. Janet Woodhouse, OT Reg (Ont), is a registered occupational therapist currently employed at Holland Bloorview Kids Rehabilitation Hospital in Toronto, and a co-creator of the Helping Hand program. Janet Bernstein, OT Reg (Ont), is a registered occupational therapist currently employed at Holland Bloorview Kids Rehabilitation Hospital in Toronto, and a co-creator of the Helping Hand program. Matthew Andres is a psychometrist and research assistant that was employed at Holland Bloorview Kids Rehabilitation Hospital during the completion of this study. Nick Reed, PhD, OT Reg (Ont), is a Clinician Scientist within the Bloorview Research Institute, an Occupational Therapist at Holland Bloorview Kids Rehabilitation Hospital, an Assistant Professor within the Department of Occupational Science and Occupational Therapy at the University of Toronto, and a member of the Rehabilitation Sciences Institute at the University of Toronto.