Practice-based evidence from a clinical cohort that received pediatric constraint- induced movement therapy.

Purpose: Constraint-Induced Movement Therapy (CIMT) is now designated a highly efficacious treatment for children with cerebral palsy, based on rigorous clinical trials. Yet virtually no evidence confirms that these moderate to large size effects can be replicated in clinical practice for a more heterogeneous clinical population. Thus there is a need to collect and report treatment outcome data based on actual clinical practice as a critical next step for implementation.

Methods: This study presents results from a prospective study conducted on a clinical cohort of 88 children, 18 months to 12 years old (M = 55 months, SD = 5 months), who received high-intensity CIMT known as ACQUIREc. The children varied in severity and etiology of their hemiparesis and a subset was diagnosed with asymmetric quadriparesis.

Results: Pre- to post-CIMT assessments confirmed highly significant and clinically meaningful changes based on both parental report (Pediatric Motor Activity Log, p< 0.0001) and standardized measures (The Assisting Hand Assessment, p= 0.04).

Conclusions: Clinical practice of high-intensity CIMT (120 hours in 4 weeks) with full-time casting of the less-impaired upper extremity produced benefits of comparable magnitude to those from rigorous randomized controlled trials (RCTs). Therapists were highly trained and actively monitored. Children across a wide range of etiologies and severity levels realized positive outcomes.