Summary of Evidence for CP
- OT Interventions most supported by EBP
- Constraint-Induced Movement Therapy (CIMT)
- Orthotics and Casting (Lower limb casting)
- Goal-directed training
- Bimanual training
- Context-focused therapy
- Home programs
- Avoid: NDT, SINovak, I., Mcintyre, S., Morgan, C., Campbell, L., Dark, L., Morton, N., … & Goldsmith, S. (2013). A systematic review of interventions for children with cerebral palsy: state of the … Reference List
Constraint-induced movement therapy constrains the dominant hand in a mitt or a cast to enable intensive training in the hemiplegic hand. For children with CP, CIMT was found to improve hand function of the hemiplegic hand. This approach is supported by randomized-control trials including reviews that confirm its effectiveness. If children meet the protocol for CIMT, often referred to as the 10 x 10 x 10 eligibility criteria in selecting a patient for CIMT:
- 10 degrees active wrist extension on the affected hand
- 10 degrees active thumb abduction on the affected hand
- 10 degrees active extension of any other two digits on the affected hand
Orthotics and Casting
- Orthotics and casting is often effective for OT interventions in many conditions.
- However, for CP, it was not found to be as effective for the upper extremities compared to the lower extremities, e.g., AFO.
- There was insufficient evidence to conclude that orthotics were effective in improving upper limb function.
- Goal-directed training AKA functional training
- Involves specific practices of child-set goals using a motor learning approach.
- Was found to be effective in improving gross motor function and hand (fine motor) function.
- Example of outcome measure: Goal-Attainment Scaling (GAS)
- Bimanual training involves repetitive task training that involves the use of both hands.
- Examples include crossing midline.
- Was found to improve hand function in children with hemiplegia.
- Was found to have equal effectiveness as CIMT.
- Involves changing or modifying the task or environment, but NOT the child or client.
- Promotes successful task performance.
- Overall improvement was seen in function (very OT).
- Research was found to be effective via a rigorous RCT.
- Involves the therapeutic practice of goal-based tasks by the child.
- Led by the parent.
- Supported by the therapist
- Context is the home environment.
- Participants saw an improved performance in functional activities as well as participation in the home environment (carry-over).
- EBP is supported by a rigorous RCT.
|↑1||Novak, I., Mcintyre, S., Morgan, C., Campbell, L., Dark, L., Morton, N., … & Goldsmith, S. (2013). A systematic review of interventions for children with cerebral palsy: state of the evidence. Developmental medicine & child neurology, 55(10), 885-910.|