Effect of Conventional Physiotherapy and Modified Constraint Induced Movement Therapy through Play way Method to Improve the Upper Extremity Motor Skills among the Children with Hemi paretic Cerebral Palsy

Abstract

There is a tendency in children with unilateral involvement to use their non-affected hand as the dominant hand, even when the actual functional loss is mild.  The potential use of the affected upper extremity of children with hemiparetic CP often fails due to “developmental non-use”, and this leads to increased muscle tone, and decreased active and passive range of motion of the joints of the limb, poor motor control, generalized weakness, and a delay in skeletal maturation. There are many systems of physiotherapy treatment for CP. Active challenging rehabilitation may prevent or minimize the adaptive musculoskeletal and behavioral changes associated with the negative features (Carr & Shepherd, 2000). Early intervention for children with CP has been advocated to help infants achieve their abilities in the most normal way for them, based on the principles of central nervous system plasticity (Shumway-Cook &Woollacott, 2001). Conventional Physiotherapy includes the following therapies:  passive or active exercise both to maintain and increase range of motion.  Active or resistive exercise increase muscle strength that may use manual resistance, free weight and training in functional skills such as bed mobility and transfers.  Physical therapy will help the child to enhance their independence, physical and emotional well-being. Conventional Physiotherapy treatment approaches focus on a mix of biomechanical, developmental, neurodevelopment, and rehabilitation models (CCHMC, 2009). This therapeutic approach involves constraining of the unaffected upper extremity using sling, plaster cast, mitt or splints and intensive training of the affected upper extremity with task-specific, goal-oriented activities by reinforcement (shaping technique). Constraint Induced Movement Therapy (CIMT) has not been studied in the pediatric population to the extent that it has been in adult with stroke. To hold a child’s interests for a long period, the types of practice used in adult CIMT need to be modified to be suitable for children.  As a result of participation, children are made to use their limbs unimanually.