Occupational therapy home programmes for children with unilateral cerebral palsy using bimanual and modified constraint induced movement therapies: A critical review

Abstract

Introduction: The home context is considered a good location for children with cerebral palsy to practise meaningful occupations. The aim of this critical review was to gain a deeper understanding of how bimanual therapy and modified constraint induced movement therapy or constraint induced movement therapy methods are used within occupational therapy home programmes from an occupational perspective. Method: A literature search was conducted using electronic databases for health research; five studies met the inclusion criteria. These were critically appraised and were analysed according to the relevant supports and barriers of the person-environmentoccupation conceptual model of practice. Findings: Family collaboration, strategic use of outcome measures, construction of the programme within the home environment and occupation-focused goals and activities emerged as commonly used methods. Enhanced descriptions of intervention context, the child's voice in defining goals and challenges in optimising occupational balance surfaced as gaps in the programmes. Conclusion: The methods used in implementing these approaches within occupational therapy home programmes requires combining motor and non-motor approaches, core occupational therapy skills, working within individual contexts and valuing family preferences. Using child-specific goal-setting instruments would strengthen the child's voice and promote participation within a wider range of occupations.

Determinants of parent‐delivered therapy interventions in children with cerebral palsy: A qualitative synthesis and checklist

“…An interventional approach that fits into the family routine facilitates confidence, capability, and empowerment (Chen, Pope, Tyler, & Warren, ; Itzhaky & Schwartz, ). Health care professionals should also recognize where families have little social support, which may adversely affect empowerment, and provide their own professional contribution towards facilitating parental empowerment (Hall et al, ; Milton & Roe, ).…”

“…This internal motivation can be influenced by external factors such as finding ways to make the intervention pleasurable. Both the parent and the child are likely to feel more motivated in the context of an intervention that is effective and deliverable as well as being suited to and tailored to their needs and goals (Carver et al, ; Dawson et al, ; Milton & Roe, ). An initial interview to explore and enhance parental motivation, appropriate education and training, and diaries to promote observation of progress are all helpful approaches (Bazyk, ; Milton & Roe, ; Novak, ).…”

“…Both the parent and the child are likely to feel more motivated in the context of an intervention that is effective and deliverable as well as being suited to and tailored to their needs and goals (Carver et al, ; Dawson et al, ; Milton & Roe, ). An initial interview to explore and enhance parental motivation, appropriate education and training, and diaries to promote observation of progress are all helpful approaches (Bazyk, ; Milton & Roe, ; Novak, ). Where appropriate, and in research settings, the child's degree of mastery motivation can be assessed formally using the Dimensions of Mastery scale (Miller, Marnane, Ziviani, & Boyd, ).…”

“…Models such as “parents as teachers and therapists” have been in existence since the late 1980s (Bazyk, ) and have become more popular over time as a result of further supporting research. Factors such as working together with the parent, establishing cooperative goals, and tailoring the intervention to the home environment are important to the success of these interventions (Milton & Roe, ).…”

“…In summary, there has been increasing interest in delivering home‐based therapy programmes through the parents of children with CP. Although there has been a recent quantitative review of this research (Milton & Roe, ), to date, there has not been an attempt to review systematically and synthesize qualitative research findings exploring the determinants of parent‐delivered therapy.…”