Constraint-Induced Movement Therapy Effects on Gross Motor Function of a Child With Triplegic Cerebral Palsy

摘要

Background and Purpose: The purpose of this case report is to describe physical therapy interventions used and gross motor functional outcomes achieved during a 3-week course of constraint-induced movement therapy for a child with cerebral palsy. Case Description: A10-year-old boy with spastic triplegic cerebral palsy underwent fine and gross motor interventions to force use of the left extremities and right lower extremity. Intervention: For weeks 1 to 2, he received 2 occupational and physical therapy sessions each week. For weeks 3 to 5, he participated in constraint-induced movement therapy, while wearing a cast 90% of waking hours. Outcomes: The Gross Motor Function Measure-88 score increased from 44.55% to 62.35% after treatment. Although he improved in one area of the Functional Independence Measure for Children, he demonstrated remarkable progress in his ability to bear weight and shift weight to his involved side in various developmental positions. Cerebral palsy (CP) is characterized by sensorimotor dysfunctions that lead to atypical muscle tone, posture, and movement. Constraint-induced movement therapy (CIMT) shows promise as an approach in treating neurologic injuries. This therapy evolved from the theory of "learned nonuse" described by Taub, in which following neurologic injury, individuals compensate by using the less-involved extremity due to depressed neural functioning of the more affected extremity. Although variations exist, CIMT consists of 2 fundamental principles: constraint of the less-affected limb and mass practice of activities with the affected limb. Constraint-induced movement therapy typically includes intense practice. Most studies use a combination of "shaping," which involves performing movements in small, discrete steps with increasing difficulty, and "repetitive task practice." Repetitive task practice involves performing a target movement in functional play or in relation to other movements. Through these types of intense practice, increased use of the more affected limb is argued to "induce expansion of the contralateral cortical area controlling movement of the more affected limb" and recruit new ipsilateral areas. The results of randomized controlled trials on CIMT in adults with mild to severe chronic strokes reveal significantly reduced motor deficits, with retention of therapeutic gains reported 2 years postintervention. Research now focuses on the use of CIMT in treating children with CP; however, few randomized controlled trials exist.