University of Virginia Health System

Constraint Induced Therapy

Background

A growing body of research shows that constraint-induced therapy is an effective approach to improving function in children with one-sided weakness resulting from neurological insult.  It has significantly improved the quality of movement and increased the amount of movement of the affected arm for many subjects.

Constraint-induced therapy was developed by Dr. Edward Taub and was first applied to the adult stroke population in the early 1990s. With refinements, it has been successfully applied to children of all ages. KCRC therapists have trained with Dr. Taub's group in the adult protocol as well as the ACQUIREc group in the pediatric protocol at the University of Alabama.

Overview

The Kluge Children's Rehabilitation Center (KCRC) offers an intensive constraint-induced therapy program for children 3 years and older with upper extremity weakness resulting from stroke, brain injury, cerebral palsy, or other neurologic disorder.

This program involves intensive therapist-guided training of the more affected arm four hours a day for four weeks for younger children. During this time the child wears a long-arm cast to increase opportunities for practice with the weaker arm. We also offer a two-week program for children aged 15 and older. Older children wear a mitt on their less affected hand for most of the day.

Fees for this program are $13,200 for children ages 3 to 15 and $8,800 for children aged 15 and older. Various factors including clinical assessment, maturity, and attention span will be considered when placing adolescents in the appropriate program and will be made after discussion with the family by the therapists. Payment is expected at the beginning of the program, with families negotiating with insurance for reimbursement.

For clinical information, contact:

For more information about scheduling, lodging, etc., contact:

Yoga for Children with Special Needs

Yoga is good for the physical body and the mind. This UVA Children's Hospital program adapts traditional yoga teachings to meet the special needs of children with disabilities. The approach is non-competitive and provides a foundation for building trust, self-confidence and a life-long form of exercise.

Ages 5 and above (siblings and friends welcome; parents invited to participate)

Instructor: Ruth Goldeen, Occupational Therapist − assisted by a physical therapist, a speech therapist, and volunteers

Next Program: Contact us. Program Flyer
Cost: $60 for six classes (scholarships available upon request)

More information: Ruth Goldeen, 434-243-6869, rag2a@virginia.edu

Secretin Therapy for Autism and Pervasive Developmental Disorder (PDD)

Several hundred children have received secretin injections for the treatment of autism and/or pervasive developmental disorder. In the only published study of this treatment, three children with autism were given an injection of secretin.  In all three cases, within one week of receiving the injection, the authors noticed less diarrhea, improvement in expressive language and less echolalia, improved eye contact, and improved peer relationships. The authors propose a link between the gastrointestinal disorders observed in many children with autism and their brain dysfunction (Horvath K, Stefanatos G, Sokolski KN, Wachtel R, Nabors L, and Tildon JT. "Improved social and language skills after secretin administration in patients with autistic spectrum disorders." Journal of the Association for Academic Minority Physicians 1998; 9:9-15.).

Secretin is a small protein hormone produced in the small intestine. Secretin helps to control digestive function by increasing the amount of water and bicarbonate secreted by the pancreas. The secretin used for injection is prepared from the duodenum of pigs, although a synthetic human version may soon be available. The United States Food and Drug Administration (FDA) has approved the use of a single injection of pig secretin to help diagnose certain gastrointestinal problems in adults.

A single injection of pig secretin is generally considered to be safe however there is no information regarding the safety of repeated doses over time, and there is no information regarding its safety in children. No double-blind, placebo-controlled studies of secretin treatment in autism have yet been published and no optimum dosage or recommended frequency of infusion in the treatment of autism have been determined at this time. Like all drugs, there is the possibility of secretin injections being associated with unexpected or unanticipated side effects.

Because of concerns of potential liability, the manufacturer of secretin has withdrawn secretin from the market. There is currently an application pending at the FDA for a synthetic version of secretion, however it is unclear if and when it will be available.

More information: http://www.nichd.nih.gov/

Biopterine Deficiency in Children with Cerebral Palsy

Only a small number of children with cerebral palsy have a form of biopterine deficiency. Dr. Richard Stevenson, Medical Director of the Cerebral Palsy Clinic at KCRC, has met multiple times with Dr. Trugman to discuss how to identify such children.

Children with cerebral palsy likely to have biopterine deficiency:

1. Have no known cause for their cerebral palsy
2. Have a normal CT scan or MRI of the brain
3. Have dystonia

Dystonia is stiffness that changes markedly with the time of day and with the child's state of excitement. The stiffness of dystonia seems to "build up" in children as they become more alert or excited or as they try to do something. Dystonia goes away completely when the child is asleep. Most children with cerebral palsy do not have dystonia but have a type of stiffness called spasticity. While spasticity may vary during the course of the day, it is always present, even during sleep.

Children with the characteristics listed above should be seen by their physician to discuss the possibility of a biopterine deficiency. A trial of medication may be warranted to see if their dystonia improves. Children who seem to improve on medication probably need further testing to see if they have biopterine deficiency.

Children with a known cause for their cerebral palsy (e.g. asphyxia or intraventricular hemorrhage), or children with abnormal findings on brain imaging (CT or MRI) do not need further assessment.

Hyperbaric Oxygen for Treatment of Cerebral Palsy

With hyperbaric oxygen therapy, a person is placed in a pressurized chamber filled with 100% oxygen. In theory, this treatment increases the amount of oxygen delivered to tissues and the extra oxygen may promote or speed healing of damaged tissues and improve the body's ability to kill germs. There is good evidence that hyperbaric oxygen therapy increases the rate that wounds and burns heal. Hyperbaric oxygen therapy is also helpful in treating carbon monoxide poisoning and decompression sickness associated with deep-sea diving (the "bends").

While there have been a number of unconfirmed reports of children with cerebral palsy experiencing significant improvements with hyperbaric oxygen therapy, there have been no scientific studies performed suggesting that hyperbaric oxygen therapy is of significant benefit for children with cerebral palsy.