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Giving Kids a Helping Hand

Mar 26, 2020 07:00AM ● By MED Magazine

Children who suffer a brain injury, infection, tumor, stroke, or other type of head trauma can be left with the lingering effects of one-side paralysis or hemiplegia. Hemiplegia in an arm causes it to be weak, stiff, and lacking in muscle control. Not surprisingly, a child’s natural response is to stop using the affected limb in favor of the stronger, healthy arm. 

“A lot of parents come in and say their child will not use that arm at all,” says LifeScape occupational therapist Jessyca Conway. 

Conway provides upper extremity rehabilitation for children with neuromotor impairments through an approach called Constraint-Induced Movement Therapy. CIMT is a scientifically-supported therapy that involves temporarily restraining the unaffected limb while offering intensive daily therapy to encourage use of the affected one. According to Cleveland Clinic, which also offers CIMT, the scientifically supported method “is emerging as a best practice for children with hemiplegia.”

“There is such great research on this,” says Conway. “We have been doing pre- and post-CIMT tests with our own kids here at LifeScape and we are seeing great improvements in grip strength and the ability to pick things up and move them.”

CIMT can be highly effective but is not necessarily easy - on children or their families. First, the unaffected limb is constrained with a cast. This alone can be frustrating for a child, who may need extra help at home doing basic tasks like dressing or feeding. The cast complicates bath time. And children who find it uncomfortable may have trouble sleeping. 

The second aspect of CIMT is intense daily therapy. For about three hours each day, a LifeScape therapist works with the child to facilitate use of the affected arm. 

“Ideally, we want to do this for at least two weeks and usually more like three, depending on the age of the child,” says Conway. “So it is a big commitment for families.”

Conway says younger children tend to get the most benefit from CIMT. LifeScape has seen patients as young as one or two years old. “Ideally, we want to see them within the year of their injury, so we can really work on those skills,” she says. “If we don’t get them until they are six or seven years old, a lot of things have already occurred that are harder to reverse.”

After two or three weeks, the cast is removed and the child is encouraged to use their new skills at home for a few months. Conway says parents are sometimes sent home with small splints or other instructions to help keep the child from regressing. CIMT may be repeated several times throughout the year with a break of two or three months in between sessions. 

“We are often able to go from the child not using the arm at all to them using it all the time,” says Conway. “It is never going to be their dominant hand, but it can be their helper hand.”

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