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news item News Thursday, November 7, 2019 Thursday, November 7, 2019 11:11 AM - Thursday, November 7, 2019 11:11 AM

Therapy with special casts helps children with cerebral palsy

Cerebral palsy (CP) is the most common physical disability in childhood. The condition affects a person's muscle tone, motor control and function. Unilateral CP, also called hemiplegia, affects muscle control and function on one side of the body. Children with unilateral CP have difficulty using their hands together and often are less aware of their more affected limb. Therapists at Shriners Hospitals for Children — Chicago's rehabilitation services held a unique camp to help patients practice using their affected arm.

All the campers wore removable casts on their less affected arm and hand. The technique is called constraint induced movement therapy or CIMT camp. Patients performed warm ups with both arms before slipping on the casts. Therapists worked with each child in the group setting to improve functional reach and grasp skills. Games like a giant sized Connect 4, outdoor relay races, and arts and crafts were all part of therapy. Samuel, age 9, participated in the two hours per day camp for two weeks. “I think having the other kids in a group helped a lot. It was more like a game, not an actual therapy session. He really enjoyed it,” Samuel’s mom Mariana said. “The kids were almost competing with one another. Let’s see who can do it faster or hold that longer.”

Therapists say CIMT works because it can help re-wire children's brains. Cerebral palsy is caused by abnormal brain development, or damage to the developing brain in utero or infancy. “Pathways in the brain are damaged and disrupted...but the brains in children have neuroplasticity, which means we are able to reroute brain pathways,” said Brian Hovorka, MS, OTRL, an occupational therapist at the Chicago Shriners Hospital who worked with the camp. “You can think of it like driving when there is a detour. You can’t take one path, but you can take another path to get there. However, children can only do that ‘detour’ in their brains with lots of practice and use of the affected arm.”

Experts agree CIMT may help. A Cochrane systematic review published in 2019 combined 36 articles that investigated the effects of CIMT as a treatment for children with unilateral cerebral palsy.  While authors acknowledge additional research is needed, the review found evidence that CIMT is an effective treatment for improving the affected arm and improving the ability to use both hands together. CIMT was also deemed to be more effective than traditional low-dose occupational therapy. 

Hovorka said assessments before and after camp showed functional improvement. “Most participants demonstrated increased grip and pinch strength, as well as improved manual dexterity skills based on measures from standardized assessments. Patients were also able to demonstrate improved accuracy using their affected arm for self-feeding and two-handed activities.” Campers practiced self-feeding by picking up hospital cafeteria trays, selecting their food and eating lunch at the hospital together, each using their more affected arm.

Samuel’s mom saw a big change in her son during camp. “You might not see the same as you were dreaming about, because whatever damage is done, is done. But you can definitely see the improvement, building muscle and strength. It becomes a habit and he uses the arm more than before,” Mariana said.

Parents and patients were given activities to perform at home on their own during the camp and after it ended. “We as parents shouldn’t forget to keep doing it. They give you a good boost, a good start with the camp,” Mariana said.

According to the Cerebral Palsy Alliance Research Foundation, 39% of children with cerebral palsy have hemiplegia. Shriners Hospitals for Children — Chicago offers ongoing CIMT therapy where appropriate for patients, along with a variety of occupational, physical and speech therapy interventions. To be considered for CIMT, Hovorka said children should have some use of their affected arm before starting the therapy. For more on multidisciplinary care for orthopaedic conditions related to cerebral palsy, visit our cerebral palsy page.

Two patients playing a gamePtient playing game with therapist