We have been studying hand function in cerebral palsy since 1991, and began developing and testing interventions based on this knowledge in 1997. Since then we have had over 300 children participate in our studies. Our staff consists of physical and occupational therapists, a neuroscientist, psychologist, and consultants include a certified social worker and pediatric neurologist. We are committed to improving the lives of children with cerebral palsy, and are sensitive to the needs and interests of children. Thus all our activities are conducted in the most child-friendly means possible. We know that efficacy depends on how we engage children rather than the use of restrictive devices on the unaffected hand.
Our program differs from most other CP treatment camps in that we do not simply take existing therapies (PT and OT) and apply them more intensively. Rather, we have built our treatment models from the the ground up using theoretically defensible ingredients gleaned from the basic neurosciences, child development and motor learning disciplines. We are not trying to prove that "our method" works or is the only or best way. Rather, we are committed to evidence-based models of medicine, and we are constantly revising and improving our treatments and testing their efficacy. We regularly present these findings to the clinical community and publish them in peer-reviewed journals so that others can build from here. Therefore, participating may not only help your child, but may also help us improve standard care.
Thus far, Constraint-Induced Therapy (CIT) and Hand-Arm Bimanual Intensive Therapy (HABIT) have been shown to be beneficial across the children we have tested, and most participants have been delighted with the outcome. Nearly all children do show improvements, and part of our screening project involves selecting participants who from our vast experience are deemed likely to improve. Improvement may be dependent on: the level of impairment, the amount of practice that occurs during the intervention, and the amount of practice using the involved hand and arm that occurs at home. Minimally, you can expect that your child will have fun participating.
Both CIT and HABIT have been shown to be efficacious. In fact, our findings to date suggest equal efficacy although our current work is aimed at understanding any subtle differences should they exist. It is possible that for a specific child, one may be better than the other depending on age, level of hand impairments, and focus. Presently we are examining this possibility.
No. We were the first to test in in children with hemiplegia starting in 1997 and have had more than 200 participate in our constraint program. However, we modified it significantly from the adult (casting) model to make it as child-friendly as possible, and use a removable cotton sling instead. We believe that CIT has an important role in rehabilitation, but we do not believe it is the "be all, end all approach". We think it can be better, and there can be alternatives.
We understand. It is a personal philosophy whether to have your child participate in a CIT treatment, and we respect your decision either way. Note that it does not have to be provided with casts or in an invasive manner. Dr. Gordon participated in an international concensus on pediatric CIT in 2012. The concensus was: regardless of claims, there is NO EVIDENCE THAT ANY ONE APPROACH IS SUPERIOR TO ANY OTHER APPROACH because approaches have never been directly compared! In the absence of such evidence, we choose to conduct CIT in the most child-friendly way possible. Nearly all children enjoy participation. Even if one approach were better, CIT can be performed multiple times during childhood (and adulthood) with added benefit. So why aim for anything other than an enjoyable experience that can be done again and again as needed? Nevertheless, we initially developed HABIT as an alternative without use of a restraint.
We wish all children could participate! However, we conduct our treatment camps in the context of a research study. Participant selection is based on the likelihood a child will benefit from participating so as not to waste the time of the family. Also, we need to be able to measure changes that occur, which depends on the age, cognition, and severity of impairment. Our criteria are meant to maximize the chance that your child will benefit if he/she qualifies. Currently, the ages for recruitment into the upper extremity study are 6 years - 17 years, and the ages for recruitment into the upper/lower extremity study are 4 years - 17 years. The intervention is fairly intensive and is designed to be child-friendly for these ages. However, we may adapt the design to be more appropriate for younger children, so please contact us if you have a child with hemiplegia of any age.
Currently the ages for recruitment into our studies are 4 - 17 years. The intervention camps are fairly intensive and are designed to be child-friendly for children above 4 years. We will be beginning an EARLY TRACKING AND INTERVENTION project in the near future where we follow development of hand function from diagnosis until ~18 months of age, and subsequently provide advice and early treatment. Please contact us if you are interested.
No. It simply means that the way we deliver the services may not be optimal for your child, or that we won't be able to capture changes based on our measures at the current moment. Depending on the child, there is still a good chance that he/she would benefit if the services are delivered in an alternative manner elsewhere. Additionally, it is encouraging that a number of children who did not initially qualify for our studies have worked with their therapists and families to subsequently gain sufficient hand function to benefit from our camp a year or several years after the initial prescreening.
No. We view the intense treatment as creating a window of opportunity. Subsequent use and practice at home would be required to retain any improvement if seen. Thus, we train parents with some basic strategies to continue to build on what we achieve.
These series of studies have been designed and funded to examine the efficacy of this intervention. At this point, information about the intervention is still being collected and assessed in order to determine if there are changes in involved hand and arm function as a result of a child receiving this intervention. Therefore, we do not currently recommend that it be offered as a therapeutic technique. Therefore, we do not provide training to therapists or parents outside the context of our study. Having said that, there are many groups who do charge for similar services and we have heard that parents were satisfied in many cases.
No. While we have PTs and OTs on staff and there are some similarities, we have developed the intervention from the ground up based on principles of neuroscience and child psychology. We are committed to translational research on evidence-based practice. Intensity is a key component, but structured practice is equally important.
Participation is fun! To the child, it is largely play and most children adapt quickly and would like to return (many have!). For such intensive therapy to work, we need to make the environment as enriched as possible.
Our intervention camps take place in the Movement Sciences Program which is located in Thorndike Hall, Teachers College, Columbia University (525 W. 120th St. New York, NY 10027).