| Constraint-Induced Therapy (CIT) has been shown to improve function of the upper limb in adults presenting with unilateral weakness following a stroke. Several studies have investigated the effects of forced use and CIT with children and current literature has demonstrated efficacy in this population. The intervention involves restraining the uninvolved upper limb, thereby promoting intensive practice with the impaired upper limb. Previously, only two studies used quantified measures to report outcomes. This is the first study to investigate the effects of CIT on self-esteem.; In the present study, three children (ages 8, 11, and 13) participated in the 14-day intervention which took place in the home. A customized sling on the uninvolved upper extremity was worn 6 hours per day while the children were engaged in structured activities using the impaired upper extremity. The children were evaluated prior to the intervention (pretest), the day after the intervention (posttest), and at two subsequent follow-ups: 4 weeks and 6 months. Videotaped frame-by-frame analysis of upper limb movement during performance of three functional tasks (palmer-grasp, precision-grasp, and a pointing task) was recorded for movement time. In addition, the Self-Esteem Index (SEI) was administered at each testing interval. Participants and their parents/caregivers were interviewed using a five-question, semi-structured format. Responses were tape-recorded and transcribed verbatim.; Movement time for all three participants improved on the difficult palmer-grasp task and was maintained through the 6-month follow-up. Although no changes in overall self-esteem could be directly attributed to CIT, it was noteworthy that one subscale on the SEI, Personal Security, declined at the posttest for all participants. This finding suggests that while CIT improves motor performance, it simultaneously appears to impact one component of self-esteem. This potentially adverse affect should encourage therapists to offer psychological support and consider implementing CIT in group settings in the pediatric population. Results suggest that several factors should be taken into consideration to guide intervention decisions. |
