A study that will look at the efficacy of a new treatment for children with hemiplegic cerebral palsy, those who have normal use of one arm and impaired use of the other, will take place at Teachers College, under the direction of Andrew Gordon, Associate Professor of Movement Sciences. The study is funded by a grant from the National Institute of Child and Human Development (NICHD).

Based on the successful results of intervention in a national clinical trial being done with stroke patients developed by Drs. Edward Taub of the University of Alabama and StephenWolf at Emory University, this study is being undertaken to explore the possibility that these children have residual capabilities that are not normally apparent due to the habitual disuse of one arm or hand. The premise of this intervention, according to Gordon, is to constrain the good hand and provide massed practice or intensive therapy to the paretic limb, the hand or arm that has weakness.

"We have run a number of children through preliminary studies in our lab over the last few years and found it to be a promising intervention," Gordon said. "Currently existing therapies for these children are limited and focus on developing compensatory strategies. We believe that because young children have greater plasticity in the brain, they have greater potential to improve hand and arm function than even the adults in other studies, even though they have had very positive results."

In creating this intervention, Gordon explained that the therapy had to be adapted for children. Whereas, the stroke patients in previous studies were asked to do boring repetitive tasks and massed practice, children have a more limited attention span and need to be engaged in fun activities. "One of the challenges in this study is that stroke patients previously had use of their paretic hand, these children have never had use of their paretic hand," Gordon explained. "They were born with this and it is a greater challenge to get them to use it. They don't know any other way."

Originally, the interventions were intended to take place in the child's home, but for a number of reasons, the study was set up to take place at Teachers College and is done with a camp-like set-up. The children are usually in the same room as other children, but each is engaged with a therapist.

"Everything is structured carefully to allow the child to be continually challenged," Gordon said. "Tasks are always in their range of capabilities and they are given positive encouragement and reinforcement."

The activities the children are engaged in include games that have been chosen based on specific types of movement patterns, as well as opening doors, locks, turning light switches on and off, and putting on and taking off shoes. In this setting, the children are timed every day to determine how well they are doing, and they are encouraged to do better than they did the day before.

The staff, which consists of masters and doctoral students from Teachers College as well as student volunteers, physical therapists in training, and undergraduates from all over the country, meets an hour at the end of each day to review the progress of each child and brainstorm how to modify the activities to help with problems specific to the individual child.

The project director, Jeanne Charles, is a physical therapist and social worker who is also a doctoral student in Movement Sciences at the College.

Nine children have been involved in preliminary intervention studies, and the researchers hope to work with another 20 children in the next few weeks and are looking for candidates for the intervention. The requirement is that the children are mainstreamed in school with relatively good intellectual cognitive function, Gordon said. The children chosen need to have hand function that fits within a relatively narrow criteria, and they cannot already use both hands equally.

"Participation in this study provides the children with a free two-week intervention, which includes one-on-one clinical therapy for 60 hours, and a $50 stipend," he added.

Children who are accepted into the study are tested immediately prior to the intervention to determine their usage level of the affected arm or hand. Subsequent tests are administered at one week, one month and six months following the intervention. Blind evaluations are done, comparing the treated group to a delayed treatment group.

In addition, parents are provided with a rating scale of activities that require usage of both hands, and they are interviewed by the researchers to rate their child's use of both hands and the quality of that usage.

While the researchers don't expect the treated extremity will become completely normal, they do believe the children will begin to use the affected arm or hand more in everyday life. "We are hoping there will be changes in brain function that provide a window of opportunity to use their hand and arm in a way that they have never been used before," Gordon said.

The types of tasks that are focused on by the researchers could have implications for both academic and social skills in the children's lives. "Holding a page of a book open while reading or putting pressure on paper while writing or drawing are typical skills that they lack," Gordon noted. And socially, he said, older children want to look like other children who do not have that disability.

"We are trying to determine which age group will give the best results," Gordon said. "Plasticity is decreasing in older children, but motivation might be greater."

Additionally, the study will include the determination of the dosage effect, meaning how often and for how long the treatment will be given. Researchers also are looking to find whether these types of activities can be put into usual and customary care settings.

"The system is not set up to do this treatment for children because it is 60 hours of therapy in two weeks," Gordon said. "Usually, a half hour of therapy is given two to three times per week." So researchers will look at what would happen if the therapy is distributed over a three- to four-month period.

Published Tuesday, Dec. 10, 2002