Unlocking potential for children with hemiplegic cerebral palsy
To all the amazing parents, families and caregivers of children with cerebral palsy,
Navigating the world of cerebral palsy, and the treatments available can be overwhelming and challenging. This post is aimed at providing some basic information for you to help you on your journey on the therapies available to help improve your child’s arm and hand function.
First, let’s talk about hemiplegia, which is commonly seen in children with a diagnosis of cerebral palsy. Imagine having limited use or no use in one half of your body. Sounds challenging, right? Well, for our young champions with hemiplegia, it’s their daily reality. But here’s the beautiful part – with the right interventions, we can make a world of difference.
State-of-the-Art Interventions: What’s Hot Right Now
- Constraint Induced Movement Therapy (CIMT): It sounds complicated, but it’s fairly simple and incredibly effective. We gently restrict the stronger arm (usually with a mitt or soft cast), encouraging the child to use the weaker one alongside repititive practice of shaping tasks at the just right challenge! This repetitive use can often lead to improved function over time
- Bimanual Therapy: Humans are bimanual beings! As the name suggests, this approach involves using both hands together to perform tasks. This is essential because many everyday activities, from tying shoes to playing ball, need two hands. By training in a fun and engaging way, we ensure that both hands can work in harmony.
Wondering about the science behind these interventions? A groundbreaking article by Novak in 2020 titled “State of the Evidence Traffic Lights 2019” beautifully summarizes best practices for children with cerebral palsy. It’s a game-changer, and I highly recommend taking a look if you’re into the nitty-gritty of evidence-based practice. CIMT and Bimanual therapy are both listed as “green” interventions indicating they have a strong evidence base and are therefore strongly recommended in the treatment of arm and hand dysfucntion for children with cerberal palsy. Basically – CIMT and Bimanual therapy were given the ‘green’ light!
Here’s the reference (it’s a free article so head to google to find a copy!):
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7035308/
Why Early Intervention Matters
You’ve probably heard the phrase “the early bird catches the worm.” When it comes to therapy for kids with hemiplegia, the earlier we start, the better outcomes we can achieve. This is because young brains are more adaptable, and we can guide them towards developing functional pathways. Did you know that in occuptional therapy we can see children for early intervention as young as 3months old? As this is the age when they start to use their hands and arms in a more goal directed manner. But no matter what the age is, getting started with the most appropriate treatment for the child and family (and their specific goals at the time) is a good place to start.
Now let’s dig deeper into what these interventions involve for kids with hemiplegia:
What is Constraint Induced Movement Therapy (CIMT)?
CIMT is an evidence-based approach originally designed to improve the function of the weaker or less-used arm and hand in adults and children with hemiplegia. The therapy involves two main components:
- Constraint: Traditionally, the unaffected arm is restrained (e.g., using a mitt or cast) to encourage the use of the affected arm.
- Intensive Task Practice: The child engages in specific, repetitive activities and tasks to improve the function of the affected arm and hand.
Modified CIMT for Children Modified CIMT adapts the traditional method to better fit the needs and comfort levels of children. The key modifications typically involve:
- Less or no constraint of the unaffected arm.
- Tailoring exercises to be more child-friendly and enjoyable.
- Adjusting intensity and duration to suit the child’s comfort and attention span.
The Importance of Other Components in CIMT
While the idea of constraining might draw attention, it’s essential to understand that the constraint is just one part of the program. Other components play a more critical role in fostering positive change:
- Shaping: This involves breaking down tasks into simpler steps, making them more achievable. As the child progresses, tasks become more challenging, promoting continuous learning and adaptation.
- Intensity: Engaging the affected limb intensely is key to driving change in the brain and improving function.
- Repetition: Just like learning a musical instrument or a sport, repetition is the key to mastering any skill. The more a child practices, the better they get.
- Behavioural Change: A significant part of CIMT is about building a child’s confidence in using their affected limb. This requires behavioural techniques to encourage, motivate, and reinforce the use of the affected arm in daily life.
Benefits of Modified CIMT
Research has shown that children who undergo modified CIMT can experience:
- Improved hand and arm function
- Greater confidence in using the affected limb.
- Enhanced independence in daily activities.
Now we know a bit more about CIMT, let’s have a look at Bimanual therapy:
What is Bimanual Therapy?
Bimanual therapy is an intervention designed to enhance the functional use of the affected arm and hand in children with unilateral cerebral palsy. Humans are bimanual beings! The use of two hands together is how we interact with our world! All humans have one dominant hand and one non-dominant (or helper) hand. For children with hemiplegia, this difference is alot more pronounced so they often prefer to try and interact with objects and their world one-handed. This can make alot of daily tasks requiring two hands very tricky!
Bimanual therapy promotes the coordinated use of both hands in functional tasks, as the name suggests, and is based on the idea that intensive and repetitive practice of two-handed, or bimanual, tasks can lead to improved hand function.
The Evidence Behind Bimanual Therapy
Two leading researchers in this field, Brian Hoare and Iona Novak, have made significant contributions (among many other amazing researchers and clinicians) to our understanding and application of bimanual therapy.
- Brian Hoare: In one of his seminal works, Hoare et al. (2010) demonstrated that task-specific training, where children engage in meaningful, goal-directed activities, can lead to improvements in hand function. The study underscored the importance of intensity, repetition, and task specificity in rehabilitation. Another interesting point that Hoare has emphasized through his research is the necessity for individualized treatment plans that focus on a child’s specific goals and needs.
- Iona Novak: Novak’s extensive research has highlighted the efficacy of bimanual therapy, among other interventions, for children with CP. One of her notable contributions is a 2013 systematic review which found strong evidence to support the use of bimanual training in enhancing upper limb function. Novak and her team also emphasized the importance of goal-directed practice and the role of parent involvement in therapy.
Key Benefits of Bimanual Therapy:
- Enhances the functional use of both hands in daily tasks.
- Is centered around the child’s interests, making therapy engaging and motivating.
- Encourages neuroplasticity, the brain’s ability to reorganize and form new neural connections.
- Incorporates parents and caregivers, ensuring that the skills learned in therapy are transferred to daily routines at home.
A Little Chat with Your Health Team
Okay, here’s your gentle nudge from me: don’t be afraid to ask your child’s health team about these interventions. Not everyone might be updated with the latest techniques (and that’s okay!). But if they’re unfamiliar, it’s your right to seek someone who is.
Why Choose Us?
Here at our practice in Nambour on the Sunshine Coast, we’re not just providing therapies; we’re building futures. With a special focus on providing CIMT and bimanual therapy programs, we’re all about intensive yet FUN sessions. Because let’s face it, kids should be kids! They learn best when they play, laugh, and enjoy. And the results? They truly speak for themselves. It’s not just about improved motor skills; it’s about the confidence, independence, and joy that come with it.
In Conclusion
Navigating the world of cerebral palsy can be challenging, but remember, you’re not alone. There’s an entire community ready to support, guide, and journey with you. And always, always, keep advocating for your child – because they deserve the best.
Stay strong, keep learning, and always remember that every small step is a leap towards a brighter future!
Helpful websites and resources:
https://www.uab.edu/citherapy/
References:
- Hoare, B., et al. (2010). Constraint-induced movement therapy in the treatment of the upper limb in children with hemiplegic cerebral palsy. Cochrane Database of Systematic Reviews, (9).
- Novak, I., et al. (2013). A systematic review of interventions for children with cerebral palsy: state of the evidence. Developmental Medicine & Child Neurology, 55(10), 885-910.