C.I.M.T. Versus Intensive Occupational Therapy

A conclusion was drawn from a recent study by Wallen etal from Sydney, Australia that modified constrained induced therapy (CIT) isn’t any more effective than intensive occupational therapy. The study was conducted on activities of daily living and also upper limb outcomes for children with hemiplegic cerebral palsy.
 Dr. Stephanie DeLuca  of the University of Alabama at Birmingham and her colleagues who have long been involved in CIMT research and raise some  questions about the Wallen study. They state:
We raise many  issues about the Wallen  study and also present directly comparative data from another trial of CIMT that we recently completed. The purpose of the comparative data is to assist readers to better interpret the magnitude of changes reported among children in both Wallen  treatment groups – for an objective outcome and a subjective one.
The concern is  that when clinical trials are conducted in a way that doesn’t clearly specify the intervention treatment or to document its fidelity of implementation, readers will be at a loss as to how to use the findings. Strict clinical trials have  agreed upon standards as to what constitutes adequate, objective outcome data. Based on the Wallen article, the  study did not meet criteria of what a rigorous clinical trial with appropriate primary outcomes should be.
The professional field is eager to solve critical questions about whether Constraint-Induced Movement Therapy (CIMT) works, and also for whom it works best, and which dosage or constraint yields the best results. The Wallen  study is described as if it answers  these questions. In fact, we judge the form of administration  and the dosage (below 1.5 hr/day) and form of constraint (a glove worn less than 1.5 hr per day) of the so-called “modified” Constraint-Induced Therapy to be an insufficient way of knowing if it in fact was really  CIT.
We feel that the field needs to develop very clear and agreed upon definitions for various therapy approaches, with  definitions and measures of the delivery of the components of this specified form of therapy. If not, we fear that CIMT – which till now has been  one of the most promising evidence-based therapies that is available for children who have unilateral cerebral palsy  –  may end up as earlier “popular” therapies that were not well defined (like Neurodevelopmental Therapy – NDT) and that it becomes a  disrespected therapy since no one can describe exactly what it is. In Dr.DeLuca’s view, the use of a short-term type of constraint with only a little more than a one hour therapy session each week cannot qualify as CIMT!
Children need evidence-based treatments. The field needs a trustworthy and solid  database to decide on  treatment recommendations and the therapist’s training  who deliver treatments. Wallen’s study  failed to clarify or even advance the role of CIMT per se. It did, however,  show that low dosages of CIMT don’t  produce large and statistically significant improvements in function even though some parents liked the intervention and were satisfied with the progress their children made.
When it becomes necessary to restrain one limb so that the weaker one can be involved in intensive therapy the TUTOR system is a preferred physical therapy solution.
The TUTOR system involves a number of components in particular the use of repetitive task-oriented training. This involves the person practicing a series of short tasks with the weaker arm for several hours a day over a two to three week period under supervision by a trained therapist. Whilst using the weaker arm the unaffected side is restrained, for example by wearing a mitt or glove to continually remind the person to use the weaker arm.
The person is encouraged to use the weaker arm outside of the treatment program for functional tasks at home whilst wearing the glove or mitt and is provided with a series of home assignments to complete. Research has proven that such intensive and repetitive use of the weaker arm over this short period leads to increased use of the weaker arm as well as improved quality of movement .
The HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR are physical therapy products that are currently being used by physical and occupational therapists to provide intensive therapy to children and adults affected by CP and many other limb disabling diseases and surgeries. The TUTORs are comfortable and ergonomically designed gloves and braces that are strategically placed on affected parts of the body. They are fit with sensors that are connected to exclusive software  allowing the patient to exercise his limb. Physical therapists monitor and record the patient’s progress and then design a customized program for that patient. Even when the patient has recovered enough to return home from a hospitalization his exercise sessions can continue to be monitored by the therapist through the use of telerehabilitation. Currently in use by leading U.S. and European hospitals and clinics the TUTORs are fully certified by the FDA and CE.
See WWW.MEDITOUCH.CO.IL for further information.

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