Midpoint Check In – Constraint Induced Movement Therapy

Constraint-Induced-Movement-Therapy-Child With Hemiplegia Cerebral PalsyHenry, a pediatric stroke survivor who has hemiplegic cerebral palsy, is in the middle of constraint induced movement therapy (CIMT), nearly exactly at the half-way point. The first few days were impossible, for a variety of reasons. Let’s start with I didn’t really know to expect, or exactly what my role would be. I had planned out so many things, took time off of work to focus on Henry,  prepared a little “therapy station” out of the train table in the playroom, set up a play date with his best bud and had a bottle of my favorite red wine on hand as my own reward. The simple stuff though, eating mac and cheese at his favorite place just down the street from the clinic led to him banging his cast over and over on the table coupled with screaming at the top of his lungs. During the lunch rush. (I assessed the situation and quickly turned it into a picnic, but should realistically never have attempted to begin with.) Eating would prove to be supremely difficult. In no time at all he’d clear the table with a sweeping motion of his cast, tossing his dinner, beverage, and whatever else was in the way right onto the floor. So, lesson learned. Water is better than milk, or at least is easier to clean up. Sippy cups, pulled them out of storage and gave them a second life.

We made it through the first couple of days, and then he had to go back to school. The biggest learning curve after the first two days: with so much focused on Henry, I had little brain power available for the everyday nonsense. The vet tech with an attitude left me in tears, just incapable of processing rudeness on top of everything else. So, one of the wisest women I know made me promise to “just let the vet stuff go and focus on Henry.” And I did. And it helped immensely to not try to make everyone happy, to accept that wouldn’t happen and to intentionally not care. To just let everything else go and focus on Henry.

His teacher’s first question was “what exercises did they give you to do?” Um, yeah. They didn’t. I left the occupational therapist’s office for three days of solo time without really a clue as to what our process would be. I did prop a fork in his hand, and helped him eat that way during mealtime. I made sure we took lots of time for tactile input in his palm, and tried to focus on just getting him acclimated to not being as independent for the time being, but exercises? Yeah… not at all on my radar. But clearly, something I should be doing.

Day three of  CIMT was our first visit back to the occupational therapist’s office. There she showed us the exercises that we should be working on. Basically we sit at a table and have Henry roll a ball to us. Fast, Slow, gets a point when he does it with “righty” and loses a point if he bats at it with his cast. After twenty points, he gets an M&M. We did a modified wheelbarrow with a swing holding the bulk of his weight, again with M&M’s as his reward, and she always put the M&M in his affected hand and assisted him in getting it to his mouth. Ok. I can do this. First stop, at the store to pick up some M&M’s.

Now, with a plan, we tackled the weekend. We’re doing exercise reps and he’s earning M&M’s left and right (well, technically, just right!). We have another occupational therapy visit tomorrow and I’m just sure she’ll comment on how well we’re doing. I’m just sure of it. But now I’m thinking scientifically again, and I’m questioning what new neural connections are actually being made here. Yes, he’s using his right hand for big movements, stretching up to reach the ball, able to control his movement enough to “aim” for a spot on the table… but he’s also using his casted arm to assist his right, propping his hand up and propelling it to his mouth to eat those M&M’s. And what I think we’re most successfully setting him up for is a future career as a professional apple bobber. He’s part Hoover, sucking up his dinner without using either of his hands, playing “puppy” and lapping up his beverage. My understanding is that in order for the brain to create new neural-motor connections, the need has to be great enough. I’m just not sure that we’re going to see the progress I was hoping for, that perhaps the casted hand work-around is getting reinforced just as much as the M&M yielding exercises. We’ll see… as hard as the first 5 days have been, if tomorrow’s appointment doesn’t reward our efforts, we may pull the plug and get back to our lives.

This article is the second in a series of articles written by Beth about her experiences with Constraint Induced Movement Therapy. Read the first article.

Article written by Beth. Beth is a mom of two, Charlotte (7) and Henry (3) in a small town in rural America. Henry had a stroke in utero and as a result has Cerebral Palsy and Right sided hemiplegia. Beth still regularly Googles how to correctly spell Cerebral Palsy. She would describe her parenting style as somewhere in between desperately hopeful and cautiously optimistic, and is tremendously excited to blog about her parenting adventure on CHASA.