Baby-CIMT as Part of a Rehabprogram for Unilateral CP Especially for Very Young Infants

Aims: Twelve years ago, I started to add constrained-induced movement therapy (CIMT) to our established neurological development training. The question was: could the hand and cross-motor skills get more benefit?

The biggest problem was not teaching infants “freewalk.” My point was to avoid the “learned nonuse” of the affected side at a very early age (range, 6–8 weeks) and to minimize the upcoming problems in the upper and lower limb. The adolescent children seemed to suffer more under the deformity of the extremity than under the lack of function.

Methods: In the beginning, the infants had to wear a glove continuously until they had learned to use the affected hand. I introduced the program to the parents and trained them to play with the baby in the way the baby prefers to act with the hemiside. It was important that it was integrated into the daily routine. The motor skills of the hands of the first months are very simple, such as, sucking, opening and closing, as well as touching mom/dad or toys. As soon as the infants used the affected hand, I included bimanual training as well. They had to wear the glove in intervals. We used repetitive training units.

Results: A total of 15 infants attended our project, 13 patients stayed with the program and as expected they reached all the motor milestones. They learned to manipulate with the hemihand. The result depends on the severity of the brain injury. At a very young age, the infants accepted the glove much better than older children. In the follow-up, none of the children developed scoliosis, hipluxations, and contractures so far. The difference in growth between the two extremities was much less, so that the handicap is not directly obvious to see.

Conclusion: The early intervention led to the better results. The training of the very young infants was easily performed because they had not realized the difference between the function of their hands. The intellectual and personal development of the older children seems to be more an obstacle than a profit. This project raises a lot of questions. Studies for these young children are needed to be done.

Keywords: early intervention, CP, CIMT, plasticity.