Effect of mCIMT Casting on Speech-language Outcomes in Children With Hemiparesis
Condition: Speech and Language Disorder; Cerebral Palsy; Hemiplegia; Hemiparesis
MeSH terms: Cerebral Palsy; Hemiplegia; Paresis; Language Disorders
Study type: Interventional

Summary: 
      Modified constraint-induced movement therapy (mCIMT) has been successfully used with children
      who have hemiplegia (weakness or paralysis on one side of the body.) mCIMT uses a removable
      cast during treatment and home exercise programs. It has been found that mCIMT can improve
      use, strength and coordination of a child's affected hand, and may also help improve speech
      and language skills. The goal of this project is to investigate whether combining mCIMT with
      speech therapy will enhance speech outcomes in children with cerebral palsy.
    

Detailed description: 
      Children with cerebral palsy (CP) often have hemiplegia, meaning only one side of the body is
      affected. They may have difficulty with daily tasks that require two hands. They may also
      have difficulty with speech and/or language. Constraint-induced movement therapy (CIMT) is a
      treatment that has been used to help improve children's performance of everyday activities
      and enhance their quality of life. CIMT uses a cast on the unaffected arm to encourage use of
      the affected hand. In traditional CIMT, a child wears a non-removable cast 24 hours a day for
      a duration of time. A more child-friendly version, modified constraint-induced movement
      therapy (mCIMT), uses a removable cast during treatment and home exercise programs. It has
      been found that mCIMT can improve use, strength and coordination of a child's affected hand.
      Preliminary studies have also shown some speech and language improvement in children with
      speech impairments who participated in mCIMT.

      The goal of this project is to investigate whether combining mCIMT with speech and language
      treatment (SPT) will enhance speech outcomes when compared with SPT alone. We will examine
      (1) whether it is feasible and effective to deliver (SPT) and mCIMT simultaneously, and (2)
      whether providing mCIMT simultaneously with SPT leads to greater gains in speech-language
      outcomes than SPT alone? Such information could add valuable evidence-based treatment options
      for children with hemiplegia and comorbid speech-language deficits, change the way in which
      we plan patients' care, and help justify co-treating patients who get mCIMT. We hypothesize
      that forced use of the impaired limb in therapeutic tasks would have spread effects resulting
      in increased rate of speech-language improvement during treatment intervals when the patient
      is casted.
    

Intervention name(s): Speech-language therapy (SLT); Modified constraint-induced movement therapy (mCIMT)
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Age-appropriate play activities with speech-language pathologist (SLP) to elicit speech, using stimulation strategies including but not limited to recasts, expansion, parallel talk, interactive modeling, communication temptations, and phrase completions. Activities will include an age-appropriate story, pretend play (i.e., house with people, playing with a baby doll), an assembly task (i.e., building blocks, making pretend pizza), and a highly motivating, clinician-controlled activity (i.e., blowing bubbles, swing, pushing cars down a ramp).; Participants will wear a removable cast and an occupational therapist will be present during therapy to focus on facilitating play with the affected arm.
Intervention model: Single Group Assignment
Intervention model description: Non-concurrent, multiple-baseline across participants
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: speech delay; one-sided weakness