Study on the effectiveness of modified constraint-induced movement therapy and self-regulation learning for students with hemiplegic cerebral palsy in school-based setting

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Study on the effectiveness of modified constraint-induced movement therapy and self-regulation learning for students with hemiplegic cerebral palsy in school-based setting

 

Author: Wong, Ying-man Kenny
Title: Study on the effectiveness of modified constraint-induced movement therapy and self-regulation learning for students with hemiplegic cerebral palsy in school-based setting
Degree: M.Sc.
Year: 2009
Subject: Hong Kong Polytechnic University -- Dissertations.
Cerebral palsied children -- Rehabilitation -- Case studies.
Occupational therapy for children.
Movement therapy for children.
Department: Dept. of Rehabilitation Sciences
Pages: xiii, 80 leaves : ill. ; 30 cm.
Language: English
InnoPac Record: http://library.polyu.edu.hk/record=b2302520
URI: http://theses.lib.polyu.edu.hk/handle/200/5120
Abstract: This study examines the effect of a new protocol of combining modified constraint-induced movement therapy (mCIMT) and an active learning strategy - self regulation (SR) in promoting upper limb function of children with hemiplegic cerebral palsy (CP) studying in a school-based setting. The protocol incorporates more self-initiated practice time on daily routine and during lessons and less time in therapist-guided structured practices in a therapy room. Ten children diagnosed with hemiplegic CP with a mean age of 13.6 years (age 9 to 18 years) were involved. A within-subjects design was used with children acting as their own controls. The study was scheduled at three-week intervals. All children underwent conventional occupational therapy (OT) and modified constraint-induced movement therapy plus self regulation (mCIMT + SR) program. Both programs lasted for three weeks. Each program was followed by a three-week no-treatment period to measure carry-over effect. The OT program consisted of training on unimanual and bimanual tasks for 1 to 2 hours a week with daily home exercise. The mCIMT + SR program involved restraint of the unaffected upper limb of children using a cotton sling for 6 hours per day for 15 days. A one-hour structured task practice with the use of SR was provided during each 6-hour restraint. Subtest 5 and subtest 8 of the Bruininks-Oseretsky Test of Motor Proficiency, the Jebsen-Taylor Test of Hand Function, the Caregiver Functional Use Survey, a hand dynamometer, pinch gauge, and modified Ashworth scale were used for evaluation. All children were assessed for five times at 3-week interval: once before and twice after the conventional OT; and twice after the mCIMT + SR at 1 week and at 3 weeks. The results indicated that children showed significant improvements in upper limb coordination, speed and dexterity, functional use of upper limb and hand strength after receiving the mCIMT + SR program and these gains sustained for at least 3 weeks post treatment. Children also demonstrated significant positive changes in upper limb coordination, speed and dexterity and functional use of upper limb following the OT program, but carry over effect was relatively weak on the whole. The findings suggest that the mCIMT + SR program demonstrated effective outcomes in enhancing the upper limb function for school children with hemiplegic CP. The increased time of practice during lessons and routine and use of SR during the structured practice were regarded as cost-effective. The mCMIT+SR program appeared to be a practical protocol for children studying in school-based setting. Future research should focus on the mechanism of cortical reorganization for improved function in children after mCIMT + SR program. Feasibility of using this protocol on children of different age, and/or mentality levels should also be studied.

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