Modified Constraint-Induced Movement Therapy at Home—Is It Possible? Families and Children’s Experience

Abstract

Modified constraint-induced movement therapy (mCIMT) is efficient at improving upper limb non-use. The experiences of families and children with mCIMT could allow researchers to understand how it influences their day-to-day life and to improve the function of the affected upper limb without altering family life and avoiding frustration. In this qualitative study, we aimed to collect the experiences of parents and their children (aged 4–8 years) who did mCIMT at home regarding the application of low-intensity modified constraint-induced movement therapy to improve the affected upper limb functionality in infantile hemiplegia with moderate manual ability. Individual semi-structured interviews were performed to obtain insights into their experience with mCIMT. The experiences of parents and children were described in thematic sections. Eight children with hemiplegia (six years, standard deviation, SD: 1.77) and their parents were asked about their experiences after applying 50 h of mCIMT at home. Three main themes emerged from the children’s interview data: (1) the experience of wearing the containment in the modified constraint-induced movement therapy (CIMT) intervention, (2) the reaction to performing the therapy at home with his/her family, and (3) learning of the affected upper limb. In the parents’ interview data, there were two main themes: (1) the difficulty of executing an intensive therapy protocol (mCIMT: 50 h) at home and (2) the feeling of not wanting to finish the intervention. The experiences of the parents and their children regarding mCIMT allowed us to understand the facilitators and barriers that affect the execution of mCIMT at home, and this understanding allows us to improve its future application.

Combined intensive therapies at home in spastic unilateral cerebral palsy with high bimanual functional performance. What do they offer? A comparative randomised clinical trial

“… 63 , 64 The execution of previous training for therapy at home, deciding on the activities and times of the day to do them, as well as the weekly follow up, favour the family’s adherence to the intervention. 30 These programmes allow families to stay at home and not to travel to the therapy centre several times a week, arranging childcare for siblings, and requiring the child to be absent from school. 65 , 66 As a barrier, these home-based programmes may be stress inductors for parents.…”

“…intensity, repetition, feedback) of the therapies established with the child. [25][26][27][28][29][30][31][32][33][34] Home-based bimanual intensive therapy (BIT) and constraint-induced movement therapy (CIMT) are found to be among the most used intensive treatment approaches directed to USCP because their application reduces the limitations within the child's daily activities, obtaining more participation in the natural environment due to increasing functionality of the affected upper limb. 28,29,31,32 BIT is a form of functional training (with intensive repetitive practice) and focuses on improving coordination of the two hands using structured task practice embedded in bimanual play and functional activities.…”

Shall we start? Ready, set, go! Toward early intervention in infants with unilateral cerebral palsy. A randomized clinical trial protocol

“…The activities will be the same as planned in the infant-mCIMT (see section ‘Infant-mCIMT protocol’) but without using the restraint in the unaffected upper limb. 23 , 24 …”

“…The activities will be the same as planned in the infant-mCIMT (see section 'Infant-mCIMT protocol') but without using the restraint in the unaffected upper limb. 23,24 Families follow-up For the three intensive therapy groups (infant-mCIMT, infant-BIT, and infant-hybrid) and the CG, a weekly follow-up will be carried out by a pediatric physiotherapist. The follow-up is aimed at resolving the doubts of the parents about the different therapies (unimanual/bimanual activities, restraint type or complications in its use, massage maneuvers.…”

Parenting and Health: The Major Challenge of Complex Relations

“…Third, parental behavior in the face of interventions (medical, psychological, social, educational, or multidisciplinary) raised by health needs, developed in different contexts (school, hospital, domestic, residential care, etc.) that may or may not require the learning of new parenting skills has been studied, which includes the work of Palomo-Carrión [16].…”