Occupational Performance Issues of Children with Hemiplegia after Acquired Brain Injury.

Aims: This retrospective, exploratory study aimed to examine the categories and frequency of occupational performance issues (OPIs) identified by children (or their caregivers), who participated in a two-week, group-based modified constraint induced movement therapy program, Helping Hand. The effect of participant age on the OPIs identified was also explored.Methods: OPIs were identified using the Canadian Occupational Performance Measure for 46 Helping Hand participants, prior to program participation. Descriptive statistics including the frequency of identified OPIs were used to categorize the 236 OPIs into occupational areas. Descriptive statistics were also used to determine how the categories of OPIs and relative frequencies differed based on participant age.Results: The identified OPIs were diverse, and differed in frequency of identification and level of specificity. The OPIs identified varied based on participant age, with age groups showing developmentally appropriate differences in OPIs.Conclusions: Identification of OPIs should balance client-centredness with probing for specificity, in order for OPIs to be understood by clinicians. This will guide future program development and interventions that target age-appropriate occupational priorities.

Retrospective Analysis of an Ongoing Group-Based Modified Constraint-Induced Movement Therapy Program for Children with Acquired Brain Injury.

AIM: A pretest-posttest retrospective design was used to evaluate the impact of a group-based modified constraint-induced movement therapy (mCIMT) program on upper extremity function and occupational performance. METHODS: 20 children ages 3 to 18 years with hemiplegia following an acquired brain injury participated in a 2-week group mCIMT program. Upper extremity function was measured with the Assisting Hand Assessment (AHA) and subtests from the Quality of Upper Extremity Skills Test (QUEST). Occupational performance and satisfaction were assessed using the Canadian Occupational Performance Measure (COPM). Data were analyzed using a Wilcoxon signed-ranks test. RESULTS: Group-based analysis revealed upper extremity function and occupational performance attained statistically significant improvements from pre- to postintervention on all outcome measures (AHA: Z = -3.63, p = <.001; QUEST Grasps: Z = -3.10, p = .002; QUEST Dissociated Movement: Z = -2.51, p = .012; COPM Performance: Z = -3.64, p = <.001; COPM Satisfaction: Z = -3.64, p = <.001). Across individuals, clinically significant improvements were found in 65% of participants' AHA scores. 80% of COPM Performance scores and 70% of COPM Satisfaction scores demonstrated clinically significant improvements in at least one identified goal. CONCLUSIONS: This study is an initial step in evaluating and providing preliminary evidence supporting the effectiveness of a group-based mCIMT program for children with hemiplegia following an acquired brain injury.

Functional electrical stimulation therapy for recovery of reaching and grasping in severe chronic pediatric stroke patients.

Stroke affects 2.7 children per 100,000 annually, leaving many of them with lifelong residual impairments despite intensive rehabilitation. In the present study the authors evaluated the effectiveness of 48 hours of transcutaneous functional electrical stimulation therapy for retraining voluntary reaching and grasping in 4 severe chronic pediatric stroke participants. Participants were assessed using the Rehabilitation Engineering Laboratory Hand Function Test, Quality of Upper Extremity Skills Test, Pediatric Evaluation of Disability Inventory, and Assisting Hand Assessment. All participants improved on all measures. The average change scores on selected Rehabilitation Engineering Laboratory Hand Function Test components were 14.5 for object manipulation (P = .042), 0.78 Nm for instrumented cylinder (P = .068), and 14 for wooden blocks (P = .068) and on the grasp component of Quality of Upper Extremity Skills Test was 25.93 (P = .068). These results provide preliminary evidence that functional electrical stimulation therapy has the potential to improve upper limb function in severe chronic pediatric stroke patients.