Constraint Induced and Bimanual Therapy

Kennedy Krieger Institute • 707 North Broadway • Baltimore, MD 21205

Director:

Joan Carney, Ed. D.

About Our Program:

Watch a video of Taylor Wilkerson, a patient of Kennedy Krieger Institute's Constraint Induced Movement Therapy (CIMT) program, as he gets a special golf lesson from a local golf pro and his occupational therapist.

Since 2004, Kennedy Krieger Institute has offered an intensive pediatric constraint induced movement therapy program based on "best practices" derived from current research in improving upper extremity function for children with paralysis caused by stroke, cerebral palsy or other conditions.

The Constraint Induced and Bimanual Therapy Program consists of one to three hours of therapy per day for approximately four weeks to improve functioning of the more involved upper extremity. During this time, the non-affected upper limb is placed in a cast that goes from above the elbow to the fingertips for the duration of the treatments. The cast is carefully monitored by therapists, family and nursing staff for proper circulation and skin integrity. It is made in a way that it can be easily removed if necessary.

Children may be seen individually or in a small group with very individualized therapy. During the summer, a camp-like day program is offered.

At the end of the treatment, a customized home based program is developed and reviewed with the family. Patients are then seen in our follow-up clinic to adjust the home program as needed and to document the outcomes of the therapy.

The therapeutic team includes a physician who specialized in rehabilitation medicine, nurses, occupational and physical therapists and psychologists. Other specialists, including a speech therapist and educator, can be consulted as needed.

Therapy is typically covered by insurance. Our finance specialists can assist in determining this prior to treatment.

Primary Program Goals:

Our therapists work on coaxing the maximal function from the affected limb by using stimulating activities of gradually increasing difficulty. This process is called "shaping" and is based on taking small steps to achieve a specific goal. Abundant positive reinforcement is used every time success is achieved. The goal is to begin use or to increase use of the affected limb rather than ignoring it. Our goal to increase use of the affected arm and hand will allow your child to participate more fully in play, self-care and school activities. We believe that a combination of weakness, increased tone, incoordination and "learned" non-use accounts in large part for the decrease in the ability to use both hands. This program is designed to combat these factors.

Hours of Operation:

The program hours are from 8:30 a.m. - 2:30 p.m., daily. Wednesdays are half days for all patients.

Contacts:

An evaluation to determine whether a child is appropriate for this program can be obtained by scheduling an appointment to see Dr. Frank Pidcock. Please call (443) 923-2600 to schedule this appointment.

Referrals may also be made by community physicians, therapists or the family. Additional information regarding the Constraint-Induced and Bimanual Therapy Program can be obtained by calling the Nurse Clinical Care Manager at (443) 923-4587.

Constraint Induced Movement Therapy Summer Camp

Constraint Induced Movement Therapy (CIMT) Summer Camp offers children the opportunity to participate in six hours of fun-filled activities to promote increased use, strength and coordination of their affected arms and hands. Daily therapy will occur onsite with a highly trained Occupational Therapist and Physical Therapist.

Children eligible for this session should meet the following criteria:

• Have a diagnosis of hemiplegia
• Completed Kindergarten or older
• Gets along well with peers
• Spends at least 15 minutes on a preferred activity
• Can grasp items independently from the table with their affected hand

Unfortunately children are not elgible for our group based camp if they:

• Have self-injurious behaviors
• Need help standing, sitting or walking
• Are easily distracted by others or their surroundings while doing a quiet activity

For more information on the CIMT camp, contact Kristine Mauldin at 443-923-4587.

PUBLICATIONS

• Coker-Bolt, P. Garcia Reidy, T. & Naber, E. (in press) Modified Constraint Induced Movement Therapy Approaches. In Pediatric Constraint Induced Movement Therapy (CIMT): Translating Theory into Clinical Practice. Edited by S. Deluca, P. Coker-Bolt & S. Ramey. AOTA Press. Bethesda, MD
• Coker-Bolt, P. Garcia Reidy, T. & Trucks, M.R. (in press) Constraint Induced Movement Therapy for Diverse Populations. In Pediatric Constraint Induced Movement Therapy (CIMT): Translating Theory into Clinical Practice. Edited by S. Deluca, P. Coker-Bolt & S. Ramey. AOTA Press. Bethesda, MD
• Garcia Reidy, T., Naber, E. & Tsai, T. (in press). Adjunctive Treatment Approaches. In Pediatric Constraint Induced Movement Therapy (CIMT): Translating Theory into Clinical Practice. Edited by S. Deluca, P. Coker-Bolt & S. Ramey. AOTA Press. Bethesda, MD
• Garcia Reidy, T., Naber E., et al. (epub 2012) Outcomes of a Clinic Based Pediatric Constraint Induced Movement Therapy Program. Physical and Occupational Therapy in Pediatrics.
• Coker-Bolt, P. Garcia Reidy, T. & Naber, E. (2011) Cerebral Palsy. In Pediatric Skills for the Occupational Assistant. 3^rd Ed. Edited by JW Solomon & JC O’Brien. Mosby. St. Louis, MO; 301-321
• Pidcock, F.S., Garcia, T., Travato, M., Schultz, S.C. & Brady, K. (2009) Pediatric Constraint-Induced Movement Therapy: A Promising Intervention for Childhood Hemiparesis. Topics in Stroke Rehabilitation

• Brady, K. & Garcia, T. (2009). Constraint induced movement therapy: Pediatric applications. Developmental Disabilities Research Review.  15: 102 – 111 
• Brady, K., Garcia, T., Allison, K. & Carney, J. (2009). Cognitive changes following constraint-induced movement therapy (CIMT) for children with hemiparesis. Journal of the International Neuropsychological Society, vol.15, supplement S1, p.56. 

RECENT PRESENTATIONS

• Garcia Reidy, T., Allison, K. Naber, E., Boyle, M. & Pidcock, F. (2011) Comparing changes in bimanual skills with speech production gains following constraint induced movement therapy in children. American Academy Of Cerebral Palsy and Developmental Medicine 65th Annual Meeting, Las Vegas, NV.
  • Winner of Best Scientific Poster
• Ramey, S., Trucks, M.R., Deluca, S. Garcia Reidy, T. & Coker-Bolt, P. (accepted for April, 2013) From Adult to Pediatric Constraint Induced Movement Therapy (CIMT): Theory and Evidence to Inform Today’s Practices. 2013 American Occupational Therapy Association Annual Conference, San Diego, CA.
• Garcia Reidy, T. (2011, April). Right Versus Left: A Case Report of Twin Participants in a Constraint Induced Movement Therapy Program. 2011 American Occupational Therapy Association Annual Conference, Philadelphia, PA.
• Tamm-Seitz, A. & Garcia Reidy, T. (2011, April). Building a Volitional Profile: A Systematic Approach to Assessing, Documenting, and Addressing Volition in Pediatric Rehabilitation. 2011 American Occupational Therapy Association Annual Conference, Philadelphia, PA.
• Trucks, M.R., Ainsworth, D.L., Coker-Bolt, P., & Garcia Reidy, T. (2011, April). Pediatric Constraint-Induced Therapy for Diverse Populations 2011 American Occupational Therapy Association Annual Conference, Philadelphia, PA.
• Naber, E. & Garcia Reidy, T. (2011, February) Intensive Pediatric Therapy Interventions: Emerging Models of Care. American Physical Therapy Association Combined Sections Meeting, New Orleans, LA.
• Garcia, T. & Naber, E. The Correlation between the Results of Three Standardized Assessments in a Pediatric Constraint Induced Movement Therapy, (2010, April) 2010 American Occupational Therapy Association Annual Conference, Orlando, FL.
• Garcia, T., &. Naber, E. (2010, March) Global Changes After Constraint Induced Movement Therapy in Children with TBI: A Case Series.  International Brain Injury Association 8th World Congress on Brain Injury, Washington DC.
• Garcia, T., Coker, P., Trucks, M.R., Naber, E., (2010, April) Measuring Constraint Induced Movement Therapy Outcomes: Choosing The Right Standardized Assessment For Your Clinical Setting. 2010 American Occupational Therapy Association Annual Conference, Orlando, FL.
• Garcia, T., Hiller, M., &. Naber, E. (2009, November) Constraint Induced Movement Therapy: Implementing a Clinical Based Camp Model. Maryland Occupational Therapy Association Conference, Timonium, MD.
• Garcia, T., Hiller, M., &. Naber, E. (2009, November) Global Changes after Pediatric Constraint Induced Movement Therapy: A Pilot Study. Maryland Occupational Therapy Association Conference, Timonium, MD.
• Garcia, T (2009, October) A Pediatric Constraint Induced Movement Therapy Model: Harnessing Neuroplasticity for Functional Outcomes Medical Educational Services, Inc. - Professional Development Network King of Prussia, PA.
• Schultz, S., Garcia, T., Naber, E., Brady, K., Carney, J., Shore, W., Salorio, C., Pidcock, F., (2009, September) The Effects of Constraint-Induced Movement Therapy on Gait in Children with Hemiplegia. American Academy for Cerebral Palsy and Developmental Medicine 63rd Annual Meeting. Scottsdale, AZ
• Garcia, T., Naber, E., & Tomarchio, M. (2009, April) Global Changes after Pediatric Constraint Induced Movement Therapy: A Pilot Study. AOTA Annual Conference, Houston, TX.
• Coker, P., Garcia, T., & Trucks, M.R. (2009, April) mCIMT: Practical Treatment Techniques For Various Clinical Models” AOTA Annual Conference, Houston, TX.
• Garcia, T. (2009, March) Constraint Induced Movement Therapy: Harnessing Neuroplasticity for Clinical Outcomes Duquesne University, Pittsburgh PA Video conference.
• Garcia, T.&  Ledbetter, E. (2008, July) Integration of Pediatric Constraint-Induced Movement Therapy (CIMT) and Hand-Arm Bimanual Intensive Training (HABIT): A Case Study. American Physical Therapy Association conference, San Antonio, TX.
• Garcia, T., Coker, P., Deluca, S., Echols, K., Little-Hayes, P., Allgier, A. & Chamudot, R. (2008, April). Pediatric Constraint Induced Movement Therapy: A Panel Presentation of Current Models in the U.S. and Israel. AOTA Conference, Long Beach, CA.
• Garcia, T. &  Ledbetter, E. (2008, April) Integration of Pediatric Constraint-Induced Movement Therapy (CIMT) and Hand-Arm Bimanual Intensive Training (HABIT): A Case Study. AOTA Conference, Long Beach, CA.
• Garcia, T. & Stern, P. (2007, November) Evidence Based Practice: Practical Application in a Busy Clinic” Short course presented at the MOTA annual conference, Baltimore, MD.
• Garcia, T., Ledbetter, E., Brady, K. (2007, November) Integration of Pediatric Constraint-Induced Movement Therapy (CIMT) and Hand-Arm Bimanual Intensive Training (HABIT): A Case Study. MOTA annual conference, Baltimore, MD.
• Garcia, T., & Stern, P. (2007, April) Evidence Based Practice: Translating Classroom Theory to Clinical Reality”. AOTA Conference, St. Louis, MO.
• Obst, K. & Garcia, T. (2007, March) Pediatric Constraint Induced Movement Therapy” Brain Injury Association of Maryland Annual Conference, Baltimore, MD.