The Program

Ten days until we get the cast on. I am getting nervous about it. Daniel is super excited, so it helps me stay positive. I just feel bad for the poor kid. But I am hopeful that it will help Samuel long term so that is pushing me forward. As Daniel has said "We don't want to regret not doing it." Better to try all that is available, even though I do think it is a little mean!

Our OT gave me an outline of the whole Constraint Induced Therapy program.

Phase One:
A short arm cast-from the elbow to the fingertips-is placed on the child's unaffected limb for 1 month. During this time, program is as follows:
-First two weeks-out patient therapy 5 days a week for 45 minutes to 1 hour each session.
-Second two weeks-outpatient therapy at least 3 times a week for 45 minutes to 1 hour each session.
-Daily home exercise program with a minimum of 2 hours of directed task to improve use of affected limb. (I will go through daily exercises later)

Phase Two:
The short arm cast is then removed and a bivalve cast (removable) is placed on the unaffected limb for 2-3 months. During this time, program is as follows:
-Outpatient therapy 2 times per week for 45 minutes to 1 hour each session.
-Continuation and upgrading of daily home exercise program.
-Bivalve cast is to be worn for over a half of child's waking hours.

Phase Three:
Weaning down the use of the bivalve cast starting at 3-4 months.
-Continuation of outpatient therapy 2 times a week.
-Continuation and upgrading of daily home exercise program.

WHY IS THE PROGRAM SET UP THIS WAY?
The first phase is meant to provide the child with a constant restraint to allow for improved awareness and to facilitate use of the affected extremity on an ongoing basis. By having this constant reminder the child will begin to learn to use the affected extremity more spontaneously during play and daily tasks. During the first few days it is common for the child to be frustrated, which can be stressful for the parent. Therefore, the full cast is preferred rather than using a bivalve restraint because if the child knows that he can have it taken off, the child's parents will often take off a removable restraint because they are having difficulty coping with the child's frustration.

During Phase 2 and 3, the full cast is replaced by a bivalve cast. This allows for gradual reintroduction of the use of the unaffected extremity. By incorporating the use of the unaffected extremity gradually, the child has less risk of reverting to disuse of the affected extremity once again. This is because the child has learned that use of the affected extremity is possible and he has begun to build new neural pathways to facilitate use of the affected extremity.

WHAT IS THE PURPOSE OF HOME EXERCISE PROGRAMMING?
The daily home exercise programming is the "nuts and bolts" of the constraint program. In the outpatient therapy sessions, the therapist will work on specific techniques and strategies, but will also focus on establishing and upgrading home exercise program activities to be carried out in the home. Home exercise programmings is an integral part of the program because the child needs to be challenged and exposed to activities to improve his arm use constantly throughout the day, every day to allow for new neural pathways to be built, which therefore improves the child's function. If the child does not complete these home exercise program activities and relies solely on the outpatient visits, he will not be provided with enough exposure to the needed motor movements to allow for improvements in the affected extremity.

HOW EFFECTIVE IS CONSTRAINT INDUCED THERAPY, AND ARE THE RESULTS LONG LASTING?
Constraint Induced Therapy can provide significant improvements, depending upon how well the program is followed. Intensive exposure to activities through home exercise programming during cast wearing will improve immediate as well as long term functional gains. Continues encouragement to use the affected limb may be necessary after the program is ended to continue to provide the child with reminders to utilize the limb. In addition, it is possible that the child may benefit from more than one round of constraint induced therapy as he grows older to allow for further refinement of motor movements and functional use.