Is Constraint Induced Therapy Right for Your Child?

 

Is Constraint Induced Therapy Right for Your Child?

By Lee Vander Loop
CP Family Network Editor
You may have heard the term Constraint Induced Therapy (CIT) in a special-needs moms’ circle or during a therapy session with your child. Perhaps you’ve heard of its potential benefits in recent news stories. How much do you really know about CIT, and how do you determine if it’s right for your child?

Constraint Induced Therapy Defined

Pediatric Constraint Induced Movement Therapy or CIT is a type of treatment that teaches the brain to “rewire” itself following a brain injury. The focus is to restrict a child’s good extremity (arm, hand, leg, etc.) in order to force usage and improved function of the extremity needing rehabilitation. CIT often involves intensive training of the more-impaired extremity for a certain number of hours per day for a designated period of time. Children with a more severe level of spasticity or mobility impairment may require more daily hours of constraint and a longer period of intense therapy.
The CI Research Institute states that Constraint Induced Movement Therapy is the only rehabilitation technique shown to markedly change the organization of activity in the brain. Various studies have shown favorable outcomes suggesting that CIT may be a useful tool in the treatment of upper-extremity dysfunction in hemiplegic CP and other forms of CP.
Depending on the specific goals and level of achievement, it may take multiple sessions to realize the intended benefit.  Remember, you’re re-training the brain!!! Be patient.

Is Your Child a Candidate?

CIT is not appropriate for every child with cerebral palsy. Talk with your pediatrician, therapists and orthopaedic specialist to discuss whether or not your child could achieve positive results from Constraint Induced Movement Therapy.
Your child will need to be monitored throughout the course of treatment to check for any complications. Discuss with your therapist what “trouble signs” you need to look for, such as chafing, rash or skin breakdown with the restrained limb. Check fingers and toes to make sure there’s no impediment of blood flow as a result of a cast or restraining device that is too tight.

Goals

Your therapist should have a Care Plan mapped out, detailing the specifics of your child’s therapy plan, including hours per day, additional therapies being implemented and the overall duration of the CIT sessions. Request a copy of the Plan. You may want to create a chart or journal tracking and annotating your child’s daily sessions. Detail the length of time the constraint device is used and what skills your childed work on during the session.  Make notes of improvement and struggles.  This will give the therapist a better picture of your child’s progress or need for additional assistance.

Coping Mechanisms

What is CIT like for a child? Here’s an analogy. If you’re right-handed, imagine someone casting that hand, forcing you to do everything with your left! Keep in mind, you probably have normal abilities and range of motion in your left hand. What if you didn’t? What if you had no good function in your left hand and now your right hand is immobilized! While adults you have the maturity and psychological skills to cope with frustration, many children do not. Couple that with a child’s immaturity and possibly an inability to communicate and you can imagine the reaction your child may have to this type of therapy.
There will be tears! Ask your therapist how to help your child establish coping mechanisms and ways to help your child get past the frustration. Make it fun! Incorporate play therapy in your CIT sessions! You want these sessions to be productive and fun, not a screaming match between you and your child. For children with developmental disability and cognitive delay, discuss with the therapist the best ways to introduce this therapy to your child.
For children with the cognitive skills to understand, have your therapist help you explain to your child the concept and goals of the therapy. Explain the number of hours per day the constraint session will last and try to set a schedule that everyone can agree with. Be sure to consider whether or not any of the constraint hours will overlap hours your child is in school. You may want to start out small and work up. Also try to schedule hours when you can play an active roll in your child’s session. Pediatric therapy based on stringency is unrealistic. You need to be consistent but flexible. There may be days when your child just isn’t being cooperative, and you find yourself skipping an hour here or a day there. Discuss with your therapist some ideas that will give you flexibility for the unexpected.

Conclusion

As with any new therapy, consult your child’s doctors and care providers before embarking on a treatment plan. Do your research and weigh the benefits and risks before deciding whether or not Constraint Induced Therapy is right for your child.

25 Great Toys for Kids Who Don't Play With Toys

Does your child play with toys?  If so, this article isn’t for you. You should probably Google “hottest toys of 2012.”

• Is your child scared of blinking, beeping toys?
• Is your child unable to understand the rules of most games?
• Does your child lack interest in typical toys?
• Is your child delayed when it comes to basic play skills?

If the answer to any of these questions is yes, then keep reading.
All human beings learn through play.  A delay in play skills means a delay in other skills.  Toys are not necessary for play, of course.  All that’s needed are two people interacting in a fun way.  But children’s toys can be useful for engaging the attention of a child with special needs, and even more useful for expanding circles of communication and teaching other developmental skills along the way.
If you’re looking for gifts for a child who doesn’t play with toys, then here’s a list of what’s been most successful with my son and his buddies over the years.

Everyday items

1. Flashlight

My son was frightened by toys with blinking lights when he was little, but he has always enjoyed playing with flashlights.  Turning the flashlight on and off exercises fine motor skills, and provides an opportunity to practice simple words like “on” and “off.”  It also helped my son overcome his phobia of bright lights. The Mini Maglite is the right size for little hands, and it has a blink mode if you need to work on desensitizing to blinking lights.

2. Shark Sweeper

I know a few kids who don’t like toys, but they love vacuums.  The Shark Cordless Sweeper  is motorized but much quieter than a typical vacuum, plus it’s light and easy to maneuver.  There’s a clear plastic cover in front of the bristles, so curious kids can watch it spinning.  We had many hours of fun with this sweeper, and it sure got some good conversations started.  Plus our carpets were super clean.

3. Handheld Massager

Occupational therapists often recommend vibrating toys for children with special needs, and the Ribbit massager by Homedics is great for all ages.

4. Real Tools

Play often starts with imitating adult activities.  A set of garden tools with garden gloves or a real tool kit with a small hammer, screwdriver and file, along with a wood board, are a good way to teach a child to slow down and focus on fine motor activities.  Of course, adult supervision is required at all times with these tools.

A Big Box of Cool Stuff

5. Raw materials

Let’s face it – most kids would rather play with a box than the toy that came inside it anyway. Collect your empty oatmeal canisters, cereal boxes and paper towel tubes.  Help your child tape the pieces together and create something new out of cardboard and Styrofoam.  Here’s a video that shows what happened when a teacher got rid of all of the toys in his classroom and replaced them with raw materials.

6. Box of toiletries

Since kids like to imitate their parents, collect some safe toiletries and allow some messy sensory play in the bathroom: scented lotion, aloe vera gel, baby powder, bandages and gauze, a bar of soap, shaving cream and an old towel to wipe it up when playtime is finished.

7. Box of office supplies

One year, my sister-in-law gave my older son a box of office supplies, all with the logo of his favorite office store.  It took more than a year for him to work through the index cards, tape, pencils, highlighters, sticky notes, a ruler and much, much more.

Sensory Play

8. Disco Ball

Anyone who has visited the Friendship Circle’s Snoezelen knows that the lights and disco balls can be relaxing and entertaining for kids with special needs.  So a small, rotating, multi-color disco ball is a fun addition to the sensory environment at home.

9. Body Sox

A body sock is made of stretchy fabric and has an opening so that a person can step inside. Its purpose is to encourage body awareness and creative movement. For my family, it has been successful on both counts.

10. Exercise Machine

If I had a nickel for every time I had to drag my children away from the exercise machines at the rec center, I’d be able to buy my own elliptical trainer.  A mini-trampoline, child-size treadmill or air walker can get a child’s attention while working toward physical therapy goals.

11. Musical wand

My son had a phobia of bells when he was a toddler, so toys like the musical wand helped him explore metallic sounds while feeling safe and secure in my arms.  The musical wand can be a tool for pretend play as well, especially when paired with a book like “Alice the Fairy” by David Shannon.

12. Punching bag

Instead of trying to stop aggressive behavior cold turkey, which is usually impossible anyway, a punching bag  redirects the aggression in an appropriate manner.

13. IKEA egg seat

This egg-shaped seat was designed for vestibular and proprioceptive sensory needs, plus it’s perfect for playing peek-a-boo.

14. Stomp Rocket

The Stomp Rocket helps work out aggressive energy while teaching a simple science lesson.  My kids never get tired of it.  Sometimes they make their own paper rockets, too.

15. Kazoo

The box said, “If you can hum, you can kazoo.”  So I bought it for $2.  It opens the door to oral-motor skills.

16. Bean bag toss

I have a child who has the urge to throw things ALL THE TIME.  Most toys are not safe for him because of this.  I decided that he may as well improve his aim if he’s going to throw things, and a bean bag toss is safer than a baseball at this point.  The bean bag target can be varied – for example, he can throw the bean bags at cards with sight words or letters of the alphabet.

Attention-grabbing quiet toys

17. Marble run

I’ve never met a kid who didn’t love a marble run.  These toys help with visual tracking, and the best part is the building process with kids.  But they’re not safe for any child who puts toys in his or her mouth.

18. Folk toys

I remember playing with traditional wooden folk toys at my grandparents’ house when I was little.  When I was brainstorming to find toys that would get my son’s attention, I went back to my roots.  Toys like the Jacob’s Ladder and Falling Boy  engaged my son and really made him think about how they work.

19. Magformers

The magnets in this building set are encased in plastic, so there are no small pieces.  The set encourages open-ended play, and it’s a good way to explore the sensory features of magnets.  It’s one of the “quiet toys” that travels with us.

20. Magnetic gyro wheel

Kids can’t take their eyes off this toy, and it’s great for long road trips or kids who just want to watch something spin.

21. Whoopee cushion

Yes, it’s crude and vulgar.  It’s also a quick way to get a speech-delayed kid to talk.  You’ll probably get quite a bit of eye contact, too.  At $1.75, it’s a lot less expensive than an hour of speech therapy!

22. Globe

If your child loves to spin things, get a globe.   It will help with pre-literacy skills and open up new conversations about the world.

23. Hoberman sphere

I used the Hoberman sphere to teach my son the names for the colors and some simple opposite terms like “big” and “small,” “in” and “out.”  It can be hung from the ceiling as a mobile that expands and contracts, but my kids prefer to hold it on the ground.

Introducing Pretend Play

24. Play silks or old scarves

Even children who don’t want to play dress-up like the texture of scarves and play silks.  These are a good way to introduce open-ended play to kids who prefer to stick with a script.

25. Box of hats

Over the years I’ve collected all sorts of hats  for my kids.  Trying on different identities is the first step to pretend play.


By Karen Wang from Friendship Circle