Pediatric Constraint Induced Movement Therapy as Designed Using Rehabilitation Treatment Specification System

Objective(s): To develop a comprehensive list of targets and ingredients with treatment concepts of Rehabilitation Treatment Specification System (RTSS) on Constraint Induced Movement Therapy (CIMT) intervention and its application in pediatric population.

Data Sources: Integrative literature review was conducted to gain perspective and understanding for knowledge base of RTSS and CIMT among hemiplegic pediatric clients.

Study Selection: Inclusion criteria for articles were peer-reviewed, published between 2010 to 2022. Research databases used were PUBMED, CINAHL, PSYCHInfo for keywords “Constraint Induced Movement Therapy”, “Pediatric hemiplegia +Occupational Therapy”, “Rehabilitation Treatment Specification System”. 18 articles were identified, critically reviewed, and analyzed for the purpose of creating preliminary conceptualizations of collected data to develop tabulated template for CIMT within the context of RTSS framework.

Data Extraction: Data extracted from the articles reviewed were investigated for current practices of occupational therapy practitioners in use of CIMT to address upper extremity hemiparesis in pediatric patients. Data from the 18 articles synthesized and description of clinical interaction, targets, mechanism of action, dosing parameters, reliability measures, pre-test data and post-test data, follow-up data, and statistical tests used relative to CIMT as an intervention. Independent extraction conducted by the reviewer. An external reviewer who is an expert in the field was asked to review data extracted to minimize potential for bias.

Data Synthesis: Tabulated protocol for CIMT as designed using RTSS framework was developed from the integrative literature review. Representations as well as Skills and Habits were found to be the predominant group identified in the literature for CIMT. Specific clinical interaction, targets, and mechanism of action were identified during the intervention process, throughout family education, fine motor training, bi-manual training, and home programs established. Task-specific training in goal-directed bimanual play and self-care activities were implemented by therapists during clinical interactions. Dosage parameters were found in high and low dose regimen for CIMT. Ingredients were identified as verbal instruction, visual demonstration, opportunities to perform tasks activities with involved hand while unaffected hand on cast, coaching, and corrective verbal feedback for consistent correct performance of fine motor skill or self-help skill.

Conclusions: Occupational therapists using the CIMT protocol will be able to systematically identify specific targets and ingredients translated into clinical practice. The tabulated CIMT protocol offers common standardized terms which would enable more detailed documentation in a pediatric patient’s clinical record. The comprehensive list ensures delivery of evidence-based clinical practice among expert and novice clinicians and helps the field in achieving precision rehabilitation.

Author(s) Disclosures: No conflict of interest to declare.