Helping kids be 'CHAMP's with constraint therapy

University of Michigan Health System
Tuesday, 1 June 2004

Rehab program helps kids with brain injuries improve arm, hand strength

It was about a year before Sherry Ramsdell realized her son, Bailey, was not developing normally. He didn't begin to crawl or talk and missed other developmental milestones. Doctors ran tests and diagnosed Bailey with cerebral palsy.

The condition affects Bailey's left side and the toddler, now age 2, did not use his left arm or hand.

But a program offered at the University of Michigan Health System has Bailey and other children with brain injuries using weakened or underdeveloped upper extremities.

As part of the Comprehensive Hand-Arm Movement Program, or CHAMP, children wear a cast or splint on their good arm to force them to use the other arm. For three weeks, the child wears a removeable cast for up to 16 hours a day. Group and individual therapy helps the children learn techniques for using their weaker hand and arm.

"CHAMP works by a combination of the children learning new techniques for using their arm and actual changes that occur in the brain," says Edward Hurvitz, M.D., a pediatric physiatrist at UMHS. "Studies have shown us that if somebody doesn't use a part of their body, that part of the brain actually shrinks. Other brain functions replace it. So they have less function in that part of the body."

The concept is similar to children who have lazy eye syndrome and wear a patch over their stronger eye.

After two weeks in the program, Ramsdell says Bailey is already making "amazing" progress.

"He's using his hand to do things he didn't do before. He's opening it up where he almost couldn't open it before because the tone was so tight. Pushing toys or a stroller, he can use both hands now, where he didn't do that before. He walked with a lot of limp and his arm would just hang at his side. Now he's actually moving it and using it more functionally," Ramsdell says.

Hurvitz and his team measure progress by timing the children doing different tasks at the start of the program and again at the end. He says both scientifically and anecdotally the children are showing more function after the therapy.

"We're very excited about this program because it's a new intervention that seems to be working very well. It doesn't involve giving the kids any shots or pills and we're getting great results from it," says Hurvitz, associate professor of Physical Medicine and Rehabilitation at the U-M Medical School.

CHAMP began at UMHS about two years ago and is aimed at children with some injury to the brain, such as cerebral palsy, a traumatic brain injury from an accident, or stroke. Often with those injuries only one side of the brain is affected. The therapy helps that effected part of the brain to be more functional and to use the hand and arm better. At the same time, the children learn through physical therapy techniques to use what function they have in a better way. The program was originally developed at the University of Alabama in the 1990s.

"The kind of therapy that we use will depend on the age of the children. With younger children, play therapy is the most important thing. When we have older children, we might do more regular activities or exercises," Hurvitz says. "But play therapy is an important part of pediatric rehabilitation, so even with older kids we might have them do games that involve the hand quite a bit. For teenage groups, we might take them out bowling something that forces them to use that involved hand."

The program at UMHS involves physical therapists, occupational therapists, psychologists and social workers to provide comprehensive support to the families. This multidisciplinary approach helps families carry out the therapy at home.

Interviews with kids as far out as six months after the therapy have found they are still using their affected hand and arm in ways they did not before the program. Hurvitz warns, though, that the change cannot be considered permanent. The children must continue to work at using their arm to maintain function.

Ramsdell has great hopes that CHAMP will help Bailey become a champ.

"My dream when I adopted Bailey was to watch him play basketball," Ramsdell says. "So I'm hoping that eventually his left side will be functional enough that he'll be able to participate in athletics. And one day we'll get to be sitting in the stands watching him and being proud of him."

About CHAMP

To participate in CHAMP, children must meet these criteria:

  • At least six months post-injury.

  • Ability to move the arm or hand.

  • Some range of motion in the arm or hand.

  • Ability to voluntarily open or grip with the hand.

  • Mild to moderate cognitive or language deficits.

  • Ability to learn new tasks with training.

Children must first be evaluated for the program by one of the UMHS pediatric physiatrists. Call (734) 936-7175 to make an appointment.

Resources

CHAMP

Head injury resource list

About cerebral palsy

About traumatic brain injury

For more information, or to contact University of Michigan Health System, see their website at: www.med.umich.edu

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