Juli Ranstadler Dissemination

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What are the effects of constraint-induced movement therapy on the upper extremity in children with cerebral palsy? (Juli Ranstadler):

What are the effects of constraint-induced movement therapy on the upper extremity in children with cerebral palsy? ( Juli Ranstadler ) Critically Appraised Topic Summary of Search : I learned that there is definitely evidence on the effects of constraint-induced movement therapy on children with cerebral palsy, although more research is still needed. There was sufficient literature on this topic, although the majority of the studies had a very small amount of participants . A larger number of participants is needed to show the true effects of constraint-induced movement therapy. This is the biggest gap  found in the literature. The research that was found was of good quality as the majority of the studies found that the CIMT group showed statistically significant results when compared to other groups. I was able to answer my question with the results that I found throughout my research. Implications for Practice, Education, Future Research: Constraint-induced movement therapy (CIMT) and modified constraint-induced movement therapy ( mCIMT ) has shown statistically significant results in improving function of the effected extremity. Occupational therapist’s can use CIMT or mCIMT to allow the client to use their effected arm when involved in occupations. The results that were found indicate that constraint-induced movement therapy shows positive improvements on children with cerebral palsy. As the client’s begin to use this extremity more than they previously did, they have seen improvements in completing specific tasks such as self-care, activities at school, and overall motor function of the upper extremity. CIMT c ombined with BIT has been proven to show even higher improvements when compared to CIMT alone. The next step I would take as a researcher  is to advocate this type of treatment to physicians, therapists, parents, caregivers, and teachers in hopes of receiving more participants for these studies. This treatment has been proven to be fairly effective , and more children with cerebral palsy should be able to receive this treatment.     Aarts , P. B., Jongerius , P. H., Geerdink , Y. A., van Limbeek , J., & Geurts , A. C. (2010). Effectiveness of modified constraint- induced movement therapy in children with unilateral spastic cerebral palsy: Randomized controlled trial. NeuroRehabilitation and Neural Repair, 24 (6) , 509-518. DOI: 10.1177/1545968309359767 Deppe , W., Thuemmler , K., Fleischer, J., Berger, C., Meyer, S., & Wiedemann , B. (2013). Modified constraint-induced movement therapy versus intensive bimanual training for children with hemiplegia – a randomized controlled trial. Clinical Rehabiliation , 27 (10) , 909-920. DOI: 10.1177/0269215513483764 Sakzewski , L, Ziviani , J., Abbott, D. F., Macdonnell , R. A., Jackson, G. D., & Boyd, R. N. (2011). Randomized trial of constraint-induced movement therapy and bimanual training on activity outcomes for children with congenital hemiplegia. Developmental Medicine and Child Neuropathy, 53 (4) , 313-320. DOI: 10.1111/j.1469-8749.2010. 03859.x  Level of Evidence; Design Type Level II; randomized controlled trial pretest-posttest design with two groups Level II; single-blinded randomized controlled trial pretest-posttest design with two groups   Level IV; single-blinded randomized controlled trial pretest-posttest design with two groups   Subject description Convenience sampling method ; recruited from 8 different rehab facilities Convenience sampling method; recruited from a neuro-pediatric rehab center Convenience sampling method; recruited by clinicians throughout Australia Intervention investigated   Participants received modified constraint-induced movement therapy ( mCIMT ) followed by bimanual training for 8 weeks, 3 days per week for 3 hours   Participants received constraint-induced movement therapy (CIMT) for 4 weeks, 5 days a week, 4 times a day for 60 minute sessions   Participants received constraint-induced movement therapy (CIMT) for 10 days and 6 hours a day Comparison intervention   Participants performed their usual care   Participants received intensive bimanual training (IBT) for the same duration as the intervention group   Participants received bimanual training (BIM) for the same amount of time as the CIMT group Outcome measures used   Assisting Hand Assessment (AHA), ABILHAND-Kids, Melbourne Assessment of Unilateral Upper Limb Function, COPM, & Goal Attaining Scale   Melbourne Assessment of Unilateral Upper Limb Function, Assisting Hand Assessment (AHA), and PEDI   Melbourne Assessment of Unilateral Upper Limb Function (MUUL), Assisting Hand Assessment (AHA), Hand-held dynamometer, Disk- criminator , and Jebsen Taylor Test of Hand Function (JTTHF) Did the article show statistical significance between groups (Results and Conclusions) ?   Yes, the mCIMT -BIT group showed statistically significant improvements when compared to the usual care (UC) group   Yes, the CIMT group showed statistically significant improvements in isolated motor control and function when compared to the IBT group (p=.033)   The only statistically significant improvement between groups was seen in the CIMT group on the MUUL at 26 weeks follow up (p=<.001) Limitations of Study Small amount of participants, quality of treatment was not equal between groups, and the final follow up at 8 weeks was not enough to show long-term effects CIMT group received more therapy time than the IBT group, there was not enough long-term follow up, and there were not enough participants in the study The biggest limitation is there was not a true control group in this study

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