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Benefits of Constraint Induced Bimanual Therapy (CIBT) for Traumatic Brain Injury and Hemiplegia

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June 2015

My child had a traumatic brain injury and now has hemiplegia. Would she benefit from constraint induced and bimanual therapy (CIBT)?

There several unique considerations a therapist must consider when implementing CIBT with children recovering from a head injury. They include attention to task, visual deficits, motor planning impairments, impulsivity and safety issues. Since these injuries are acquired, this patient population will be slightly older and may need to balance the needs of education with intensive therapy needs. For children with a short attention span or impulsivity, a routine of activities or a picture schedule may be a helpful behavior management technique that will help them practice a skill at a high level of repetition. Setting up the environment to limit distractions may also be helpful.

If your child has difficulty understanding lots of verbal directions, simple, one-step directions may be easier for him/her to follow. The therapist should be mindful of the number of steps a child can easily follow before giving directions and during cuing. Visual impairments and field cuts also impact the presentation of materials and positioning of materials. Fine motor intervention is also a great opportunity to incorporate problem-solving strategies/motor planning into intervention. For example, while building a block tower, your therapist may have your child copy a sequence of colors, working on two skills at once.

If you have a topic or questions that you would like the Helping Hands blog to address, please email HelpingHands@kennedykrieger.org.

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