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Upper Extremity Control: Constraint-Induced Movement & Mirror Therapy

presented by Patricia C. Montgomery

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In this course, Dr. Montgomery contrasts different theoretical frameworks for motor control and reviews research on upper extremity control in children with cerebral palsy. Key elements of constraint-induced Movement therapy (CIMT) for children with hemiparesis are described. Proposed mechanisms for cortical reorganization are reviewed and clinical activities and applications are provided. A summary of mirror therapy and potential use with children with hemiparesis also is included.

Meet Your Instructor

  • Patricia C. Montgomery, PhD, PT, FAPTA

    Patricia C. Montgomery, PhD, PT, FAPTA, received a BS degree in physical therapy from the University of Oklahoma and an MA in Educational Psychology and PhD in Child Psychology from the University of Minnesota. Dr. Montgomery is an NDT-trained therapist and Faculty Emeritus of Sensory Integration International. She has taught in several physical therapy programs and is the author of multiple books and articles. Dr. Montgomery has worked in a hospital setting, a NICU, and a public school, and has a pediatric private practice. She is a Fellow of the American Physical Therapy Association and has served on its Board; she is also the past president of the Minnesota chapter of APTA.

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Chapters & Learning Objectives

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  1. Upper Extremity Research

    1. Upper Extremity Research

    This chapter contrasts different theoretical frameworks for upper extremity motor control and reviews research on upper extremity function in children with cerebral palsy. Key elements of constraint-induced movement therapy (CIMT) for children with hemiparesis are described and proposed mechanisms for cortical reorganization reviewed.

  2. Sequelae of TBI on Motor Control and Upper Extremity Function

    2. Sequelae of TBI on Motor Control and Upper Extremity Function

    This chapter is a case study of a nine-year-old female who is 18 months post a severe TBI secondary to an MVA (motor vehicle accident). She has a resulting left hemiparesis. The child had multiple extremity fractures, which have healed, but she has mildly limited range-of-motion (ROM) in both the upper and lower extremities. She is blind in the left eye and has a painful left ankle. A major sensory deficit is noted in observing her voluntary left upper extremity motor function, which is limited unless she has some type of external sensory input. The treatment session emphasizes improving her ROM and strength and providing sensory input to the left upper extremity with a focus on bilateral voluntary movements.

  3. Constraint Induced Movement Therapy (CIMT) Protocols

    3. Constraint Induced Movement Therapy (CIMT) Protocols

    This chapter discusses variations in protocols and emphasizes studies of comparisons between bimanual training (BIM) and CIMT. Specific clinical activities and applications are provided. A summary of mirror therapy and potential use with children with hemiparesis is also included.

  4. Case Study of Reach and Grasp

    4. Case Study of Reach and Grasp

    This chapter is a case study of a four-year-old male with a right hemiparesis. A treatment session is illustrated, which emphasizes treatment objectives that include: grasp and release of small objects with the right hand, weight bearing on the right UE while maintaining elbow extension during movement transitions, and full “reach” with the right UE with an open hand and fingers to touch toes. Two brief follow-up sessions at 6 ½ and 7 ½ years of age are also included.