Pediatric CI Therapy - An Interview with Dr. Stephanie C. DeLuca


As each day passes, medical research communities strive to find alternative means of evaluating and treating specific conditions. One of those communities is comprised of a professional and highly educated team of PhDs at Alabama University at Birmingham, located in Birmingham, AL. Sharon Ramey, PhD developer and head of research efforts (of Pediatric CI Therapy) with co-researchers, Stephanie C. Deluca, PhD, K. Echols, PhD., Pt. PCS, and E. Taub, PhD. broadened Pediatric CI investigations. Pediatric Constraint-Induced Therapy, (also called Pediatric CI Therapy) was initiated to further advance treatment in children suffering from neuromotor disabilities. Funded by a grant from the Alabama Health Service Foundation, the Pediatric Neuromotor Research Clinic was established and is now being co-directed by Drs. Echols and DeLuca.

CI Therapy, also known as "Taub Therapy," was initially developed by Dr. Edward Taub, Director of Taub Therapy Clinic in Birmingham, AL. A medical innovation that is successful in over 95% of stroke patients in helping regain significant movement, Taub therapy is an effective stroke rehabilitation therapy that consists of restricting the use of unaffected limbs to "rewire" neurons in the brain.

To explore Pediatric CI Therapy, I asked Dr. Deluca a few questions about this particular therapy in an informal interview:

Q [C.Bailey-Lloyd] Could you explain exactly how the therapy works?

A [Stephanie C. DeLuca] The therapy is aimed at children who have asymmetric abilities with their upper extremities because of a lesion within the central nervous system. It involves casting the child's stronger arm and hand with a lightweight splint which the children wear 24 hours a day for 3 weeks. Children are then treated for 6 hours each day for 21 consecutive days.

Q [C. Bailey-Lloyd] What can one expect from this therapy, and on average, how long is treatment necessary?

A [Stephanie C. DeLuca] This varies from child to child and is dependent on the child's incoming abilities. But children routinely develop numerous new motor abilities with the weaker arm and hand.

Q [C.Bailey-Lloyd] How long has this treatment been in use and how successful is it?

A [Stephanie C. DeLuca] We have been implementing this approach for almost 5 years with approximately 65 children and have seen very dramatic results. But again where children end up is dependent on where they start.

Q [C.Bailey-Lloyd] Are there any side effects to this treatment? Please explain

A [Stephanie C. DeLuca] In general there have been very few negative side effects. Minor discomfort with relation to the cast but that is usually very transient.

Q [C.Bailey-Lloyd] Who utilizes this therapy (in practice) and how widely is it used across the nation?

A [Stephanie C. DeLuca] We are the only clinic using the entire protocol that we are aware of.

Q [C Bailey-Lloyd] Is this therapy effective on neurological disorders/ diseases other than Cerebral Palsy and Stroke patients?

A [Stephanie C. DeLuca] That still needs to be addressed with research.

On the question of Pediatric CI Therapy effectiveness opposed to other conventional medical treatments, Dr. DeLuca referred me to recently published research efforts in a Pediatric paper. According to the research team, the stated results were"... Children receiving pediatric CI therapy compared with controls acquired significantly more new classes of motoric skills (9.3 vs 2.2); demonstrated significant gains in the mean amount (2.1 vs 0.1) and quality (1.7 vs 0.3) of more-affected arm use at home; and in a laboratory motor function test displayed substantial improvement including increases in unprompted use of the more-affected upper extremity (52.1% vs 2.1% of items). Benefits were maintained over 6 months, with supplemental evidence of quality-of-life changes for many children."

In the Pediatric Paper Conclusion, "...Pediatric CI therapy produced major and sustained improvement in motoric function in the young children with hemiparesis in the study."

In closing, Pediatric CI Therapy offers a promising alternative treatment to children with neuromotor disabilities. To learn more about Pediatric CI Therapy or if you are a Pediatric Practitioner wanting to learn how to properly administer Pediatric CI Therapy, please contact Dr. Stephanie C. DeLuca at sdeluca@uab.edu or through her Website at www.circ.uab.edu/cit.htm

Key References:

1. Taub, E., Ramey, S., DeLuca, S., Echols, K., Efficacy of Constraint-Induced Therapy (CI) Movement Therapy for Children with Cerebral Palsy, Pediatrics.

2. Pediatric Neuromotor Research Clinic www.circ.uab.edu/

3. UAB Health Systems www.taubtherapy.com/

4. New Strategies after Stroke: Restraining, Rewiring, Relearning http://main.uab.edu/show.asp?durki=28002

OTHER PUBLICATIONS

Echols, K, DeLuca, SC. (submitted). Dosage in the treatment of children: Making therapy count. Journal of the American Physical Therapy Association.

DeLuca, S.C., Echols, K., Ramey, S.L. & Taub, E. (2003). Pediatric constraint-induced movement therapy for a young child: two episodes of care. Journal of the American Physical Therapy Association: 83, 11, 1003-13.

Taub, E., Ramey, S.L., DeLuca, S.C., Echols, K. (2004). Efficacy of constraint-induced (CI) movement therapy for children with cerebral palsy. Pediatrics: 113, 2, 305-12

Ramey, SL, DeLuca, SC, Echols, K. (2003) Resilience for Today, in E. Grotberg, (Ed). Resilience In Families With Children Who Are Exceptional. Greenwood Publishing Group.

DeLuca, S.C. (2002) Intensive movement therapy with casting for children with hemiparetic cerebral palsy: a randomized controlled crossover trial. Dissertation, University of Alabama at Birmingham.

Echols, K., DeLuca, S.C., Ramey, S., & Taub, E. (2002). Constraint-induced movement therapy versus traditional therapeutic services for young children with cerebral palsy: a randomized controlled trial. Developmental Medicine & Child Neurology. 44, S 91, 29

DeLuca, S.C. (2001) Constraint-induced movement therapy in pediatrics: a review and case study. Thesis, University of Alabama at Birmingham.

Echols, K., DeLuca, S.C., Ramey, S., & Taub, E. (2001). Constraint-induced Movement therapy in the child with cerebral palsy. Developmental Medicine & Child Neurology. 43, S 88, 37

Echols, K., DeLuca, S.C., Taub, E., Ramey, S. (2001). Constraint-induced movement therapy in young children: a protocol and outcomes compared to traditional measures. Pediatric Physical Therapy. 12, 2, 210 Morris, D., Crago, J.E., DeLuca, S.C., Pidikiti, R.D., & Taub, E. (1997). Constraint-Induced movement therapy for motor recovery after stroke. NeuroRehabilitation. 9, 29- 43.

Taub, E., Pidikiti, R.D., DeLuca, S.C., Crago, J.E. (1996). Effects of motor restriction of an unimpaired upper extremity and training on improving functional tasks and altering brain/behaviors. Imaging and Neurologic Rehabilitation. 133-154.

Taub, E., Crago, J. E., Burgio, L.D., Groomes, T.E., Cook, E.W., DeLuca, S.C., & Miller, N.E. (1994). An operant approach to rehabilitation medicine: Overcoming learned nonuse by shaping. Journal of Experimental Analysis of Behavior, 61, 281-293.


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