Therapy to a Tee

July 8, 2011
Constraint-induced and Bimanual Therapy Program incorporates golf to help one patient on his path to rehabilitation.

Taylor Wilkerson works with golf pro Kelly Tomlinson to improve his swingFrom the beginning, and without hesitation, Katherine Wilkerson always offered her unwavering support of anything her son Taylor wanted to do. The thing is, though, until the age of 9, there was never much of anything the boy was too interested in trying.

Diagnosed with cerebral palsy (CP) when he was 6 months old, Taylor had little patience for the instructions and prodding of the physical and occupational therapists who tried to help him gain dexterity and functionality in his left hand, rendered weak and ineffectual by a hemiparesis -- a muscular weakness on one side of the body, often associated with CP. And so, instead of incorporating the advice of his therapists, Taylor simply learned to compensate by relying on his right side, using his left only as a helper of sorts. "He was too independent," his mother explained. "He decided he wasn't going to go along with it, and so he didn't."

But then came golf, and with it a gradual realization that he needed his left arm after all. It was a discovery that would eventually lead him to the Kennedy Krieger Institute's Constraint-Induced and Bimanual Therapy program, where a unique form of treatment awaited him.

Taylor had watched his father play golf for years, until eventually watching was no longer enough. But the game wasn’t as easy as his father made it look, especially for Taylor, who in the beginning could barely grip a golf club, let alone swing one. Still, he adapted. By the time Taylor turned 13, he'd made his middle school's golf team.

And yet even with a better swing and stronger game than most kids his age, he lacked the good grip and follow through that can make a golfer great. So when, during a beach vacation in 2009, a family friend -- and a Kennedy Krieger physical therapist -- told Taylor and his mother about the Constraint-Induced and Bimanual Therapy Program (CIBT), the boy who had once rejected the instruction of therapists, found himself eagerly seeking their help. "He came here very motivated to get his arm stronger," says Teressa Garcia Reidy, the occupational therapist who started working with Taylor when he was first admitted to Kennedy Krieger. "But his grip was weak, and his movement wasn't very coordinated or fluid."

Taylor Wilkerson works to improve his swingFirst launched in 2005, the CIBT program aims to help children with hemiparesis to learn to use their weaker limb by constraining their functional limb in a cast. It's an intensive program that can be physically and emotionally challenging for children who are already struggling to get by without the assistance of the limb they've come to rely on, all while leaning on a limb they'd long ago given up on. Patients attend several hours daily with physical and occupational therapists who strive to make therapy fun, not frustrating. "And," Reidy says, "all therapy is play-based and child-directed, which makes it pretty fun for kids."

The range of patients varies. They may work with toddlers, teenagers like Taylor, elementary school aged children and older teenagers. Sometimes, Garcia says, they'll have patients who return for a refresher course to boost their functionality. "As a clinician, I think the earlier you come to a program like this, the better off you are," Reidy says. "More and more research is supporting this kind of intensive therapy."

Perhaps making it easier for patients are the constant reminders that everything they're doing will ultimately help them succeed at something they want, a goal that plays a primary role in designing their therapy plan. A few years ago, Reidy says, therapists in the program began giving patients a questionnaire to evaluate their day and pick out problem areas. "We really look at what's important to the patient," Reidy says, "and we really listen to what they want to work on."

And from day one, what Taylor wanted to work on was golf. Knowing that, Garcia developed a plan for Taylor that focused on strengthening his grip and level of control. That plan culminated in a therapy session with a golf pro who worked with him on his swing and tried to show him how to incorporate his new-found dexterity into his swing. "I never expected anything like that," Taylor says. "I was just so excited that they would do something like that for me. I think I learned a lot about my grip and how to hold the club better."

On first glance, the regimen Reidy devised might read more like a child's summer activity list: along with golf, there were also card games, board games, basketball, and particularly golf-related video games using the highly interactive and physically demanding Nintendo Wii. Taylor Wilkerson works with golf pro Kelly Tomlinson and an occupational therapist"He went from not being able to really play the game to beating me at it," Reidy says.

While such recreational activities might not sound traditionally therapeutic, they actually play an important role in strength-building and improving dexterity. After all, to succeed they both require varying degrees of hand control and coordination in both hands.

Today, thanks to the skills Taylor's picked up in CIBT therapy, his mom says his chances of succeeding at what he wants are much greater. "If he sets his mind to something he can do it," Katherine says. "Now, if something were to happen with his dominant arm, he knows he could do okay with his left hand. And, long-term, this will open doors for him. I'm hoping that down the road he'll look back and say, 'Hey, if I hadn't done this, I wouldn't have done so well.'"