As an NHS paediatric occupational therapist I was fortunate enough to spend several years working as part of a specialist upper limb clinic.
I would assess and treat children with cerebral palsy and other neurological conditions with splinting and hand orthosis, trying to get them the best function from their hand with our very limited resources. Constraint therapy was often talked about but dismissed as too costly and time consuming with some discussions around whether it was fair to constrain a child’s more functional hand.
When I left the NHS to work for CIMT and our sister company OT for Kids, I had no idea how exciting the opportunity to treat children with a hemiplegia would be and how wrong all my preconceptions were.
When an occupational therapist assesses a child they are looking at everything that child does, everything they are and all that they want to become. Most people are not familiar with the term “occupation” when they think about the purposeful and meaningful activity a person does throughout the day but occupational therapists are experts in it. We use occupation as a way of assessing a child but also as a way of treating a child. What better way to motivate someone than to help them do an activity that they love?!
A child’s occupations are centred on play; children explore their world through play and learn about how to move, how to communicate, how to relate to others, and the world around them all through play. From play, they go onto start to learn to do things for themselves like dressing and feeding. If there is a problem or difficulty stopping them from fully engaging in their occupations, then it is the occupational therapist’s job to help them. For the child with a hemiplegia it is the affected side and resulting difficulties, such as reduced movement, difficulties with grip and dexterity and inability to rotate the hand that interfere with play and learning. For example, a child with a severe hemiplegia may struggle to use both hands together for feeding, riding a bike, taking part in P.E. or writing and drawing.
As an occupational therapist I always want the children I work with to be able to use both hands together; hands that work together get the best outcomes. Then why are you such an advocate of CIMT I hear you ask? The brain is a funny thing. It will always try and take the easiest way of completing a task, so if you have a difficulty such as a hemiplegia, the brain will always take the easiest option and make the unaffected limb do all the work, even if it means neglecting the affected side. By using both hands together the brain has to put in some work (this is a good thing!). Sometimes the brain needs a kick start to remember that the affected side can do a lot more than it thinks it can. This is where CIMT comes in. By restraining the non-affected side the brain realises that the affected side can start to work again and work better than ever. By the time we have given the child lots of different play activities and spent lots of time working on getting the brain to make new pathways to help that affected limb work, when it comes to taking the cast off we are in a great place to get both hands working together. Both hands achieving together, and the child being able to do all the activities and occupations they need to and want to.
Working in collaboration with a physiotherapist, we give the family the very best quality intervention, as they receive all the expertise from both professions and double the fun for the child. My physiotherapy colleagues may look at a particular movement or muscle whilst I look at helping the child achieve a particular task or function (using a spoon is a great example of this) and together we constantly re-assess and find the best way for your child.