Please select the eligibility criteria that correspond to the clinical trial below.
Title: Randomized Controlled Trial of Pediatric CI Therapy
Brief Summary: Pediatric Constraint-Induced (CI) Movement therapy is a rehabilitation program designed to improve motor function in children with partial paralysis. Children with cerebral palsy may have one arm that has significantly greater function (good arm) than the other (bad arm). Restricting the use of the good arm may improve the use of the bad arm. In pediatric CI therapy, the good arm is put in a sling to force increased use of the bad arm. The bad arm is also trained each day for several weeks. This study will test the ability of pediatric CI therapy to improve motor function in children with cerebral palsy.


Options:
A: Inclusion criteria:

1. Symptomatic hemiplegic CP with impairment(s) of the upper extremity including the hand (Pediatric Stroke Outcome Measure motor \>0.5; AND Manual Ability Classification System I, II,III, or IV; AND both child and parent perceive functional limitations (able to identify personally meaningful deficits in function).
2. MRI confirmed AIS-MCA or PVI (neuroradiological syndrome classified by two blinded, experienced investigators according to previously validated methods)
3. Age at enrollment: 6-18 years
4. Resident in province of Alberta for period of study
5. Informed consent/assent

Exclusion criteria:

1. Multifocal perinatal stroke or other brain injury/abnormality
2. Severe hemiparesis (no voluntary contraction in paretic hand, MACS level V)
3. Intellectual disability causing an inability to comply with study protocol
4. Unstable epilepsy (\>1 seizure/month or \>2 medication changes (dose or agent) in the last 6 months or history of recurrent status epilepticus)
5. Any TMS contraindication including implanted electronic devices
6. Botulinum toxin A injection in the affected upper extremity within the preceding 6 months
7. Orthopedic surgery in the affected upper extremity in the previous 12 months
8. Unwilling to delay any new therapeutic rehabilitational intervention directed towards upper limb function (aside from study home program) for the 6 month duration of the study
B: Inclusion Criteria

* Clinical diagnosis of hemiparetic cerebral palsy consistent with criteria in Swaiman and Russman (1999) and Badawi et al. (1998)
* Recommended for participation in pediatric rehabilitation and/or early intervention
* Lives within 50 miles of the Civitan Center at University of Alabama at Birmingham or the family is willing to temporarily relocate to the Birmingham area for treatment

Exclusion Criteria

* Profound bilateral hearing loss with the use of hearing aids
* Severe visual impairment
* Serious seizure disorder or uncontrolled seizures
* Genetic and syndromic conditions historically excluded for CP registries
* Familial Spastic Paraplegia
* Ataxic Cerebral Palsy
* Diagnosis of Pervasive Developmental Disability or autism
* Serious or recurring medical complications
* Scheduled for surgery within 12 months of study entry
C: Inclusion Criteria:

* at least 10 degrees of active finger (metacarpophalangeal joint) and wrist flexion/extension motion,
* ability to see whether a computer screen cursor is slightly above/below a target line,
* ability to understand finger tracking test evidenced by a score above 0,
* evidence of an MEP in paretic hand muscle with TMS testing of ipsilesional M1, age-equivalent receptive language function.

Exclusion Criteria:

* metabolic disorders,
* neoplasm,
* seizures,
* disorders of cellular migration and proliferation,
* lack of age appropriate receptive language function,
* expressive aphasia,
* pregnancy,
* claustrophobia,
* indwelling metal or MRI incompatible medical devices,
* gross visual field cuts.
D: Inclusion Criteria:

* Children 3-6 years of age
* Hemiparetic CP

Exclusion Criteria:

* No prior CI therapy treatments
* No Botox for 6-months

Answer: B