Constraint-Induced Movement Therapy in a Pediatric Oncology Population
Condition: Hemiplegia; Brain Tumor
MeSH terms: Brain Neoplasms; Hemiplegia
Study type: Interventional

Summary: 
      Hemiplegia (weakness or poor muscle function on one side of the body) is a neurological
      impairment which can occur in children as a result of a brain tumor or related treatment.
      This impairment can negatively impact the child's functional abilities and movement
      development, making it difficult for them to play, learn to feed, dress or bathe themselves,
      and to participate fully in home, daycare, or school environments. Poor movement skills may
      also impact overall quality of life. Constraint Induced Therapy is a rehabilitation technique
      which has been found to improve the child's abilities to move their arms following
      neurological injuries like stroke and traumatic brain injury in both adults and children.

      The aim of this study is to evaluate the feasibility of implementing a constraint induced
      movement therapy program in a small group of children with a brain tumor and hemiplegia.
      Children who participate in the program may experience improved ability to use their weak arm
      leading to increased participation in meaningful activity and improved quality of life.
    

Detailed description: 
      Constraint Induced Therapy (CI Therapy) is based on the theory of "learned non-use."
      Following an event that impacts the brain (stroke, brain injury etc.), the messages from the
      brain to the arm and the messages from the arm to the brain are interrupted in the area of
      the brain where the injury occurred and in a small surrounding area. The arm is often
      inefficient and difficult to use. Over time, even after swelling in the brain decreases,
      movement of the affected arm continues to be more effortful and the child becomes quite
      accustomed to completing activities with the unaffected arm only. Additionally, because the
      child has not used the weak arm for a while, the part of the brain that is ready to receive
      signals and give commands to the arm or leg is "quiet" and does not work like it used to. The
      theory of "learned no-nuse" has lead to the development of the CI Therapy approach which is
      comprised of the following principles:

        -  Constraint - the strong or normal arm/leg is restrained, forcing use of the weaker
           arm/leg during treatment.

        -  Practiced Use - the weak limb is treated by engaging the child in structured practice of
           specific movements and functional skills.

        -  Transfer Package - a home program is developed for the child to use with his or her
           caregivers that focuses on facilitating carryover of learned skills into the real world
           environment.

      This theory hypothesizes that, because the nervous system, particularly in the child, has
      plasticity (can be shaped and learn to do new things), CI Therapy will facilitate cortical
      (brain) reorganization, and help the child overcome learned non-use, eventually leading to
      improved function of the weak arm or leg.

      Phase 1: Initial evaluations will be completed on day 1 of the program. They include
      interview questions and direct assessment of the participant's ability to use the affected
      arm as well as to participate in meaningful age-appropriate activities. These assessments
      include the Motor Activity Log, The Pediatric Arm Function Test, the Inventory of New Motor
      Activities and Programs, the Pediatric Quality of Life Inventory, and the Preschool Activity
      Card Sort or Children's Assessment of Activity Preferences.

      Phase 2: The participant completes an intensive occupational therapy program which consists
      of 15 three-hour therapy sessions (5 days per week for 3 weeks). Throughout the three week
      program the un-involved arm will be constrained with a removable cast. The cast is to be worn
      24 hours per day throughout the 3 week program with the exception of regularly scheduled cast
      changes, washings and skin checks completed by the treating occupational therapist. During
      the direct intervention sessions, a focus of therapy is on facilitation of new motor skills
      for the affected arm. Play is utilized as a means to motivate the pediatric participants with
      activities and exercises specifically chosen to facilitate new motor skills. The program also
      includes a variety of tools and activities caregivers will complete increasing adherence to
      the program outside of the direct intervention sessions and to facilitate transfer of
      affected upper extremity use into the real world environment.

      Phase 3: Immediately following the 3 week intervention program the participant's performance
      is re-assessed. Additionally weekly follow up evaluations are completed by phone for a period
      of one month. Three months following the intervention program the participant will return for
      follow up evaluations.
    

Intervention name(s): Focused rigidity bi-valve long arm cast
Intervention type(s): Other
Intervention description(s): Two focused rigidity bi-valve long arm (upper arm to finger tips) casts will be fabricated for each participant on day one of the constraint-induced therapy (CIT) program. Focused rigidity casting materials are water proof and latex/fiberglass free. Focused rigidity casting does not require use of a cast saw for removal thus decreasing potential for anxiety during the casting process. Casts will be fabricated by therapist trained in the casting technique.
Other intervention name(s): constraint-induced therapy
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Supportive Care
Keywords: Constraint-Induced Movement therapy; Pediatric; Hemiplegia; Brain Tumor; Rehabilitation