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Babies and children with certain types of cerebral palsy can learn to use their neglected arms through an intensive form of therapy originally intended for adult stroke victims, a new study has found.
Constraint-induced movement therapy requires placing the child''s good arm in a cast for three weeks. A therapist then works with the child one on one, six hours a day, six days a week to practice movements using the bad arm. This practice, referred to as "shaping", allows the child to improve gradually.
Cerebral palsy is a term that refers to difficulties moving various parts of the body, caused by problems in brain development. Once in five cases is caused by stroke around the time of birth. Lack of oxygen to the brain, low birth weight, and maternal infections have all been linked to cerebral palsy.
The study included 18 children ranging in age from 7 months to 8 years, all of whom suffered perinatal strokes. Younger children crawled using only one side of the body and always pushed themselves up with the good arm, while older children allowed the bad arm to dangle.
Half of the children received conventional cerebral palsy therapy, working with a therapist for 2.2 hours a week practicing movements like trying to lift their arms over their heads. The other half of the group received constraint-induced therapy. Their good arms were fit with lightweight fiberglass casts. They then worked with a therapist, with activities that mostly involved play, such as popping sop bubbles, picking up puzzle pieces, pounding balls into holes with a plastic hammer, etc. When children showed new movements, they were praised enthusiastically. The therapist would then "shape" the skill by asking for more precision, fluidity of movement, or automatic response.
Children receiving intense therapy learned an average of nine new motor patterns, compared with two in the control group. One 18-month old began crawling up steps and feeding himself with his formerly neglected hand, while a 4-year old who had never used his bad arm can now play baseball.
The study was led by Dr. Edward Taub, a psychology professor at the University of Alabama at Birmingham. Dr. Taub originally developed the system for stroke patients, basing the therapy on the idea that many cells near the main site of the injury are stunned, and patients eventually give up trying to move the limb. This "learned helplessness", Dr. Taub believes, is what results in long-term loss of use. By restraining the good limb and practicing movements with the bad limb, patients overcome their learned non-use. The intensity of training and the internal rewards associated with shaping appear to be the major factors in the success rate with children, but how they have made such great improvements in only three weeks is still a mystery, according to Dr. Taub.
Children with cerebral palsy present a different sort of challenge: because they have never developed normal limb use, they are not attempting to regain movement. Their problem is called "developmental disregard".