Wednesday, 1 September 2010

FU

Indeed

Motta F, Antonello CE, Stignani CForced-use, without therapy, in children with hemiplegia: preliminary study of a New approach for the upper limb, Journal of Pediatric Orthopaedics, vol. 30, no 6, pp. 582-587
BACKGROUND: Forced use (FU) is an emerging treatment for children with hemiplegic cerebral palsy (CP). It involves constraining the unaffected arm and no additional treatment of the affected arm. Our study examined a new approach to FU in children with hemiplegic CP: that is, restraint of the unaffected limb and no rehabilitation.
METHODS: Ten children with hemiplegic CP aged between 5 and 9 years were compared with 10 control children (aged between 5 and 8 y). All participants were classified as MACS level II.The FU group wore a fixed cast, on the unaffected arm for 21 consecutive days, and, such as the control group, did not receive any physical therapy.All participants were assessed by the Melbourne Assessment of Unilateral Upper Limb Function and the Shriners Hospital Upper Extremity Evaluation.
RESULTS: A statistically significant increase in both the functional scales was already apparent after cast removal and was maintained during follow-ups. The total Melbourne Assessment of Unilateral Upper Limb Function percentage score increased significantly to 9.5% and 12.3% on 3-week and 3-month follow-up
examinations, respectively (P<0.05). A statistically significant increase was observed in 2 of the 3 parts of the Shriners Hospital Upper Extremity Evaluation: spontaneous use (P<0.05) and the ability of the involved limb to grasp and release (G/R) (P<0.05). CONCLUSIONS: These preliminary results suggest that FU without rehabilitation improves the spontaneous use and function of the affected upper limb. In children with hemiplegia, this approach may be an economically viable means of upper limb treatment that has no side effects.
LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions to Authors for complete description of level of evidence.


Usual charges (pun intended).

Am I being too oblique?

2 comments:

  1. Andrew

    I believe it was in July 2008 that I first wrote about Forced Use therapy in relation to the treatment of adults who have suffered strokes. I reported on this treatment taking place in both Germany and America. It interests me very much and I think if used in the correct environment can be extremely useful in the development of movement and therefore the ability that clients have to become more active physically.

    I was only recently made aware that this treatment is also available for children in Germany. It was in fact recommended by a neurologist to the parents of one of my new clients. A two-and-a-half year old child who has a hemiplegic motor disorder after suffering a massive seizure. The family declined the offer, as I too would have done. This child was much too young at the time and not advanced enough in her recovery to have understood the methods involved in this treatment.

    The family and I are both of the same opinion that the methods that we have used in our conductive sessions and in the child’s daily life are enough to encourage use of both hands. Immediately after the seizure the child was unable to do anything with both sides of her body. We believe she should be free to learn to use both left and right extremities again and maybe at a later date the Forced Use therapy can be tried.

    The economics

    Conductive upbringing and Forced Use therapy are actually both expensive methods perhaps they are “economically viable” as suggested in the report you quote only because they could prevent the need for expensive equipment later on in the lives of the clients. Both of these methods are therapist and conductor intensive. People and their time cost more than any equipment used in clinic or practice.

    For conductive upbringing or Forced Use therapy to be successful during the hours that a conductor or a therapist is present a client is actively solving certain tasks that are necessary for developing the skills they wish to learn. From the little I have read about Forced Use therapy I understand that it takes place in individual sessions, whereas conductive sessions usually take the form of groups. This makes Forced Use therapy more expensive than conductive education in regards to man-power.

    I find the following sentence to be extremely misleading and obviously intended to be so if the report is solely to prove the economics of the therapy.

    "It involves constraining the unaffected arm and no additional treatment of the affected arm."

    As far as I understand Forced Use Therapy does not only involve the restraint of the unaffected arm and does not mean that there is no additional treatment of the affected arm. From what I have learnt about this therapy I understand that the therapy initially takes place in two to three hour sessions . A therapist works with the client encouraging the use of the affected arm in larger movements and finer movements of the fingers, in many different activities. As the movement increases then the client is able to become more active and therefore to work, or play, alone for longer periods of time, just as in conductive upbringing.

    Anoter quote from the report:
    "In children with hemiplegia, this approach may be an economically viable means of upper limb treatment that has no side effects."

    Economically viable? It is very labour intensive so I doubt it, except in the long term as I mentioned when some equipment may not be needed, but I also doubt that this is what is meant here.

    No side effects? Perhaps not with adults, except for the positive ones, but I am not so sure when working with children. I think this depends a lot on the age of the child. For younger children I much prefer my conductive method of encouraging use of both affected and unaffected sides.

    Susie

    PS I found the posting:
    http://www.susie-mallett.org/2008/07/writing-with-mother-listen-with-mother.html

    ReplyDelete
  2. Andrew

    I believe it was in July 2008 that I first wrote about Forced Use therapy in relation to the treatment of adults who have suffered strokes. I reported on this treatment taking place in both Germany and America. It interests me very much and I think if used in the correct environment can be extremely useful in the development of movement and therefore the ability that clients have to become more active physically.

    I was only recently made aware that this treatment is also available for children in Germany. It was in fact recommended by a neurologist to the parents of one of my new clients. A two-and-a-half year old child who has a hemiplegic motor disorder after suffering a massive seizure. The family declined the offer, as I too would have done. This child was much too young at the time and not advanced enough in her recovery to have understood the methods involved in this treatment.

    The family and I are both of the same opinion that the methods that we have used in our conductive sessions and in the child’s daily life are enough to encourage use of both hands. Immediately after the seizure the child was unable to do anything with both sides of her body. We believe she should be free to learn to use both left and right extremities again and maybe at a later date the Forced Use therapy can be tried.

    The economics

    Conductive upbringing and Forced Use therapy are actually both expensive methods perhaps they are “economically viable” as suggested in the report you quote only because they could prevent the need for expensive equipment later on in the lives of the clients. Both of these methods are therapist and conductor intensive. People and their time cost more than any equipment used in clinic or practice.

    For conductive upbringing or Forced Use therapy to be successful during the hours that a conductor or a therapist is present a client is actively solving certain tasks that are necessary for developing the skills they wish to learn. From the little I have read about Forced Use therapy I understand that it takes place in individual sessions, whereas conductive sessions usually take the form of groups. This makes Forced Use therapy more expensive than conductive education in regards to man-power.

    I find the following sentence to be extremely misleading and obviously intended to be so if the report is solely to prove the economics of the therapy.

    "It involves constraining the unaffected arm and no additional treatment of the affected arm."

    As far as I understand Forced Use Therapy does not only involve the restraint of the unaffected arm and does not mean that there is no additional treatment of the affected arm. From what I have learnt about this therapy I understand that the therapy initially takes place in two to three hour sessions . A therapist works with the client encouraging the use of the affected arm in larger movements and finer movements of the fingers, in many different activities. As the movement increases then the client is able to become more active and therefore to work, or play, alone for longer periods of time, just as in conductive upbringing.

    Anoter quote from the report:
    "In children with hemiplegia, this approach may be an economically viable means of upper limb treatment that has no side effects."

    Economically viable? It is very labour intensive so I doubt it, except in the long term as I mentioned when some equipment may not be needed, but I also doubt that this is what is meant here.

    No side effects? Perhaps not with adults, except for the positive ones, but I am not so sure when working with children. I think this depends a lot on the age of the child. For younger children I much prefer my conductive method of encouraging use of both affected and unaffected sides.

    Susie

    PS I found the posting:
    http://www.susie-mallett.org/2008/07/writing-with-mother-listen-with-mother.html

    ReplyDelete