The purpose of this article was to describe a child-friendly modified constraint-induced movement therapy protocol that is combined with goal-directed task-specific bimanual training (mCIMT-BiT). This detailed description elucidates the approach and supports various research reports. This protocol is used in a Pirate play group setting and aims to extend bimanual skills in play and self-care activities for children with cerebral palsy and unilateral spastic paresis of the upper limb. To illustrate the content and course of treatment and its effect, a case report of a two-year-old boy is presented. After the eight-week mCIMT-BiT intervention, the child improved the capacity of his affected arm and hand in both quantitative and qualitative terms and his bimanual performance in daily life as assessed by the Assisting Hand Assessment, ABILHAND-Kids, Video Observations Aarts and Aarts Module Determine Developmental Disregard, Canadian Occupational Performance Measure and Goal Attainment Scaling. It is argued that improvement of affected upper-limb capacity in a test situation may be achieved and retained relatively easily, but it may take a lot more training to stabilize the results and automate motor control of the upper limb. Future studies with groups of children should elaborate on these intensity and generalization issues.
A new computer software program to score video observations, Video Observations Aarts and Aarts (VOAA) was developed to evaluate paediatric occupational therapy interventions. The VOAA is an observation tool that assesses the frequency, duration and quality of arm/hand use in children, in particular those with cerebral palsy. Reliability studies show that the first module, designed to evaluate a forced-use programme, has an excellent content validity index (0.93) and good intra- and inter-observer reliability (Cohen's kappas ranging from 0.62 to 0.85 for the three activities tested). With the built-in statistical package, paediatric occupational therapy departments can conduct therapeutic evaluations with children with impairments in the upper extremities. Further research is recommended to apply the VOAA in clinical studies in paediatric occupational therapy.
Postural control during quiet standing was examined in typical children (TD) and children with cerebral palsy (CP) level I and II of GMFCS. The immediate effect on postural control of functional taping on the thighs was analyzed. We evaluated 43 TD, 17 CP children level I, and 10 CP children level II. Participants were evaluated in two conditions (with and without taping). The trajectories of the center of pressure (COP) were analyzed by means of conventional posturography (sway amplitude, sway-path-length) and dynamic posturography (degree of twisting-and-turning, sway regularity). Both CP groups showed larger sway amplitude than the TD while only the CP level II showed more regular COP trajectories with less twisting-and-turning. Functional taping didn’t affect sway amplitude or sway-path-length. TD children exhibited more twisting-and-turning with functional taping, whereas no effects on postural sway dynamics were observed in CP children. Functional taping doesn’t result in immediate changes in quiet stance in CP children, whereas in TD it resulted in faster sway corrections. Children level II invest more attention in postural control than level I, and TD. While quiet standing was more automatized in children level I than in level II, both CP groups showed a less stable balance than TD.
