Influence of gait analysis on decision-marketing for lower extremity surgery

Multiple doses of constraint-induced movement therapy result in continued improvement

I CHARLES PT PHD A, A M GORDON PHD B

  1. 1. Emory University School of Medicine, Atlanta, GA;
  2. 2. Teachers College, Columbia University, New York, NY, USA

Background: Constraint-induced (CI) therapy has been shown to improve movement in the involved hand of children with hemiplegic cerebral palsy (CP). Recent findings suggest that the impaired hand in children with hemiplegic CP is not static, therefore CI therapy should be considered from the prospective of this continuing growth and development.

Objectives: To examine if gains as a result of an initial dose of CI therapy are maintained 12 months later, and if a second intervention thereafter results in continued improvement in hand function.

Design: An ecploratory study with a sample of convenience.

Participants: A sample of convenience (n=8) of children (5-13y) with hemiplegic CP, form a total of 30 children who had previously received CI therapy, were tested at 1-year follow-up and subsequently received a second CI intervention.

Method: Children were engaged in unimanual play and functional activities that provided structured practice with the involved limb for 6 hours per day for 10 days.

Blinded evaluations occurred once before the intervention (12mo follow-up) and at 1-week post-intervention. The parimary outcome was the Jebsen-Taylor Test of Hand Function (unilateral measure of speed and dexterity). Secondary outcome measures included: the subtest Speed and Dexsterity of the Bruininks-Oseretsky Test of Motor Proficiency and the Caregiver Functional Use Survey (CFUS), a caregiver survey of involved upper extremity use at home.

Results: Statistical analysis: repeated measures analysis of variance with post-hoc analysis of simple effects. There was a significant main effect of testing session (pre- vs post-testing) when the first intervention was compared with the second intervention for the Jebsen-Taylor test (1st 381s [SD 223] to 338s [SD 211]; 2nd 335s [SD 210] to 299s [SD 162]. A main effect was also found for the Bruininks and CFUS (all p<0.05). Overall, significant changes in movement of the involved limb as a result of the initial intervention were maintained at the 12-month follow-up (p>0.05).

Conclusions: Results suggest that there were generally similar changes in involved upper extremity performance over both intervention sessions. Furthermore, these children demonstrated long-term retention of increased movement efficiency and caregivers’ perceptions of movement in the involved limb after an initial dose of CI therapy.

 
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