Constraint-Based Therapy to Improve Motor Function in Children With Cerebral Palsy

Cerebral palsy afflicts at least two in 1,000 children in the United States and
approximately 2,000,000 children worldwide. Behavioral techniques that impact the plasticity
of the nervous system need to be incorporated into practical, evidence-based therapeutic
interventions for this condition.

CI therapy was derived from basic research with animal and human subjects. Randomized,
controlled studies indicate that it can substantially reduce the motor deficit of adult
patients with mild to moderately severe chronic strokes and can increase their independence
over a period of years. CI therapy involves motor restriction of the less affected upper
extremity for a period of 2 to 3 weeks while concurrently training the more affected upper
limb. This gives rise to concentrated, repetitive use of the more affected extremity. In
adults, CI therapy has lead to a large increase in use-dependent cortical reorganization
involving the recruitment of substantial new regions of the brain in the innervation of more
affected extremity movement.

The study will evaluate CI therapy in a pediatric population. The study will test whether
pediatric CI therapy can promote new and improved motor behavior in young children with
hemiparesis associated with cerebral palsy. Pediatric CI therapy involves total restraint of
the unaffected upper extremity with simultaneous repetitive use of the affected extremity
for 6 hours/day for 21 consecutive days.

Fifty-two children ages 2 to 6 years old with hemiparetic cerebral palsy will be randomly
assigned to either the pediatric CI therapy group or to a control group. The control group
will receive standard rehabilitation therapy. All children will have a complete medical
evaluation with emphasis on motor function prior to treatment initiation. Children will
undergo follow-up testing at 1, 6, and 12 months post-treatment. The primary study
assessment tools are the Pediatric Developmental Motor Scales - II (PDMS-II), DASI – II,
Bayley Developmental Skills Test, Pediatric Motor Activity Log (PMAL), Child Arm Use Test
(CAUT), and Emerging Behavior Scale (EBS).

Inclusion Criteria

- Clinical diagnosis of hemiparetic cerebral palsy consistent with criteria in Swaiman
and Russman (1999) and Badawi et al. (1998)

- Recommended for participation in pediatric rehabilitation and/or early intervention

- Lives within 50 miles of the Civitan Center at University of Alabama at Birmingham or
the family is willing to temporarily relocate to the Birmingham area for treatment

Exclusion Criteria

- Profound bilateral hearing loss with the use of hearing aids

- Severe visual impairment

- Serious seizure disorder or uncontrolled seizures

- Genetic and syndromic conditions historically excluded for CP registries

- Familial Spastic Paraplegia

- Ataxic Cerebral Palsy

- Diagnosis of Pervasive Developmental Disability or autism

- Serious or recurring medical complications

- Scheduled for surgery within 12 months of study entry