Designers: Kyle Smith, Lynn Wang
Client Coordinators: Jodi Petri, OT, Lenox Baker Children’s Hospital
Supervising Professor: Dr. Larry N. Bohs
The goal of Constraint Induced Movement Therapy (CIMT) is to force patients with hemiplegia to use their affected arms by restraining their healthy arms. This therapy has been shown to provide significant improvements in some patients. Currently, therapists at Lenox Baker Children’s Hospital (Durham, NC) use a Delta-Cast that patients undergoing CIMT wear for 3 weeks, 24 hours a day, in an outpatient treatment. The Delta-Cast is a polyurethane resin cast with Velcro straps that is formed around the patient’s elbow, forearm, and hand. This device has two major shortcomings. First, Delta-Casts do not cover the fingertips, so some patients use their unaffected arm and negate benefits of the therapy. Second, Delta-Casts must be custom made for each patient. We developed a novel device for CIMT in children with hemiplegia. The device immobilizes the fingers, hand, wrist, and elbow of the child’s unaffected arm, forcing use of the affected arm. It easily adapts to children with different sized arms, and is re-useable. The device is relatively inexpensive, comfortable, attractive, and easily constructed from commercially available products.
How this project helped
The CIMT device meets its functional objectives while being cost and time efficient, easily reproducible, adaptable to a wide range of potential patients, and easy for parents and patients to use. Therapists do not need to be specially trained to use this device, and customizations made to the device can occur during patient fitting and patient/parent education. Once constructed, the device easily adjusts to fit a range different arm sizes. The hospital can purchase two or three hand splints for both the right and left hands, allowing CIMT devices to fit a wide age and size range. This device should reduce the cost of CIMT therapy because it can be re-used, and requires less therapist time to assemble and fit.
The three components of the CIMT device are: (1) elbow brace with elbow flexion/extension restraint, commercially purchased and modified with a small aluminum stay to fix its angle at 135°; (2) commercially purchased hand splint made of a malleable aluminum frame with a removable lining, and added Velcro supination/pronation straps; and (3) stretchable sleeves to enclose the device for aesthetics. Each component is durable and easy to put on; straps used with the hand splint are color coded to ensure correct strap direction. The device uses an adjustable commercial hand splint to increase the range of patients fit and to provide the ability to order additional sizes to fit different ranges. The orientation of the straps on the commercial hand splint allows the supination/pronation restraint and the hand restraint to be merged into one unit. The supination/pronation straps are 2″ wide Velcro extensions of the hand splint straps that wrap around the forearm in opposite directions and attach to the Velcro-sensitive elbow brace. Neoplush placed between the Velcro straps and forearm prevents abrasion. The sleeve of the device was adapted from arm warmers used by bicyclists in cool weather. One of the sleeves is made of CoolMax, which is available in a range of sizes and colors; children may also decorate their own sleeve because of its low cost. Cords threaded through the seams on both ends act as drawstrings. The lower drawstring is permanently cinched and tied to prevent its opening. A cord lock on the upper drawstring holds the drawstring tight, preventing the patient from removing the sleeve and thereby potentially removing the device. A knot can be tied for further restraint as necessary. The cost of parts and material was about $120.