Please select the eligibility criteria that correspond to the clinical trial below.
Title: Phase1 Effectiveness of a Modified Constraint-Induced Movement Therapy Program in Rehabilitation of Arm Paresis in Children With Cerebral Palsy: a Cross-Over Study
Brief Summary: The purpose of this study is to determine if a modified protocol of constraint-induced movement therapy (CIT) is effective in rehabilitation treatment of arm paresis in children with cerebral palsy. In these children one main problem the non-use of the affected arm. Many studies showed that the non-use phenomenon can by reversed by the CIT, a rehabilitation program consisting of 15 days of restraining the unaffected arm plus a daily intensive (6 hours/day) physiotherapy training of the paretic arm. The present study aims at evaluating if a shortened CIT protocol (restraining device plus only 2 weekly hours of physiotherapy) is effective in improving use and function of children paretic arm


Options:
A: 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.
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:

* presence of mild-moderate arm paresis (after cerebral palsy) enabling to
* reach and grasp a pellet
* age between 1-10 years
* active participation during proposed activities
* parents consent for participation -

Exclusion Criteria:

* presence of severe behaviour disturbances
* presence of severe mental retardation (QI\<60)
D: 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

Answer: C