FORCED USE OF THE UPPER EXTREMITY IN CEREBRAL-PALSY - A SINGLE-CASE DESIGN

Objective. Muscle imbalance and poor control of movement can have an i mpact on the daily occupational functioning of children with cerebral palsy. When one side of the body functions better than the other, chil dren will often prefer to use the less-involved upper extremity for co mpletion of play and self-care activities because they have learned th at the other hand does not function as effectively. This study examine d a method purported to overcome this learned nonuse of the affected u pper extremity by directing the child; attention to this extremity and increasing his other motivation to use it. The research hypothesis wa s that restriction of the less-involved hand with a resting splint wou ld result in increased use of the more-involved hand in a child with s pastic cerebral palsy. Method. Initially, two children with cerebral p alsy participated in this single-subject, ABA design study, but only o ne subject complied with the splint-wearing schedule and completed the study. This subject was a 2-year-old girl with greater involvement of the right side than the left. During the experimental phase, she wore a resting splint on her less-involved hand for most of the waking hou rs of the day to restrict its use. Data were collected over a 7-week p eriod (2 weeks presplinting, 3 weeks splinting, 2 weeks postsplinting) and at a 6-month follow-up. Use of the more-involved extremity was me asured through analysis of her performance during 15-min videotaped se ssions of free play, administration of items from the Peabody Developm ental Fine Motor Scales, and completion of a daily finger-feeding task . Results. An improvement in quality quantity, and variety of use of t he more-involved extremity after splinting, with some continuing impro vement evident at follow-up, was found The subject had increased volun tary control of her more-involved arm and hand and used them more spon taneously for completion of daily occupations, Conclusions. Although t he results of this single-case design are encouraging, further researc h with a randomized, controlled design is necessary to determine the e ffectiveness of the forced-use technique with a larger population.