Muscle Work

Constraint-induced movement therapy for neuromotor disorders.

What do you do when the doctor tells you your child has had a stroke, endured a brain injury, has hemiplegia, or is experiencing something called a neuromotor disorder? You “Google it,” right? Because none of it makes sense at the time, what else is there to do? What do you do next? What is the right course of action, and what are the therapies to try? Neuromotor disorders are very complex, and they are unique to each person, which makes each child’s road different.

Neuromotor disorders are conditions that affect how the brain sends signals through your nerves to your muscles. Typically, children with neuromotor disorders have one side of the body that is more affected than the other. The condition can manifest through a floppy or flaccid appearance or a tight or overly contracted appearance with a lot of muscle tone. Overall, the brain is having difficulty telling each muscle how to properly move for a variety of different reasons. Some children are born with a neuromotor disorder secondary to complications during the pregnancy or at birth, and some children acquire a neuromotor disorder secondary to an accident or illness.

There are many treatment options available for children with neuromotor disorders, but the trick is to find the right combination for your child. Common treatments include bilateral integration that focuses on the use of both hands, therapeutic horseback riding, sensory integration that seeks to regulate sensory issues, traditional occupational and physical therapy, and constraint-induced movement therapy. In order to best choose what will most benefit your child, you first have to determine your child’s individual strengths, what goals you have for your child, and your child’s goals and aspirations. Capitalizing on the strengths of your child and his goals is the key to determining the most successful course of treatment.

A form of therapy that has really taken off in recent years for children with varying neuromotor disorders is constraint-induced movement therapy. The main goal of constraint-induced movement therapy is to show individuals with varying neuromotor disorders, who primarily experience having one arm more affected than the other (hemiplegia/ hemiparesis), that they can do many things they never thought possible.

In the clinic where I’m an occupational therapist, we work with children for four weeks at a time, six hours a day, five days a week in a home-like environment. Each child is fitted with a cast that is placed on the functional arm/ hand. This gives the child time to strengthen the individual muscles of the less functional arm/hand without the distraction of the functional and more dominant side taking over like it usually does.

After intensive work with the affected upper extremity through play and functional activities, children are given time for bilateral work (using both hands) based on their individual goals. The goal is to give each hand a task to achieve in everyday activities, and it’s made more likely by repetition and consistency. For small children, the goal could simply be dressing themselves or tying their shoes with two hands. For a teenager, the goal could be learning the simple, two-handed functions of a job she hopes to gain, or putting her hair in a ponytail.

Living one handed in a two-handed world can be very challenging for children, and therapists aim to facilitate their development in order for them to reach their full potential. Using two hands can be time consuming for some individuals with neuromotor disorders, but if they start early with the proper interventions, they can find lasting rewards. Don’t underestimate your child’s abilities until you have given them a fair chance. We never know what our bodies, and even ourselves, are capable of until we push past what we already know.

For additional information about constraint-induced movement therapy and neuromotor disorders, take a look at these resources:

  • UAB Pediatric Neuromotor Clinic at www.uab.edu/civitansparks/pediatric-neuromotor
  • International Alliance for Pediatric Stroke at www.iapediatricstroke.org
  • Children’s Hemiplegia and Stroke Association at www.chasa.org