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Camp turns challenge into fun therapy
Seven little children gathered in the College of Health Professions
(CHP) last week learning how to do what ordinarily would have been
physically impossible—use both of their hands, arms, legs and feet.
Nathan Jacumin, 4,
works with an MUSC occupational therapist during a Western Day at Camp
Hand to Hands for children with hemiplegic cerebral palsy. The camp is
focused on various activities to strengthen a child’s weaker hand or
leg. Nathan’s splinted left hand is covered with a puppet to encourage
him to perform a theme-oriented task with his weaker, right hand.
That might seem simple for most active children, but for this group of
children, ages 3 to 6, it’s a matter of overcoming a cerebral malady.
Despite their racial and cultural diversity, these children share the
same challenge posed in having hemiplegic cerebral palsy (HCP).
HCP is a condition caused by a static lesion in the brain that shuts
down the use of one side of the body, similar to what many people
experience following a stroke. “The good news is that HCP is
non-progressive, but loss of muscle tone and motor function typically
causes developmental problems,” said occupational therapist Patricia
Coker, an instructor for the Occupational Therapy Educational Program,
in the Department of Rehabilitation Sciences.
At MUSC’s Camp Hand to Hands, these children actually have fun as part
of learning how to use legs, arms and hands through constraint-induced
movement therapy. Constraint-induced therapy isolates or immobilizes
the dominant or working hand so that the patient is forced to use the
weaker hand or foot. It was developed in the 1980s to help stroke
survivors regain use of impaired limbs. Researchers at the
University of Alabama at Birmingham (UAB) applied this type of stroke
therapy to children with hemiplegic cerebral palsy, which affects
one-fourth of all children with cerebral palsy.
The UAB model, considered the benchmark, Coker said, involves a 21-day,
one-on-one regimen between the therapist and child at a cost of
about $16,000. It is the nation’s largest program for children with
HCP. The problem is that it’s time-consuming and cost-prohibitive for
Coker adapted the UAB model, by reducing the overall time while
maintaining the basic elements of constraint including massed practice
and shaping of more mature motor movements.
Camp Hand to Hands incorporates a unique therapeutic approach first
created in 2001 by physical therapist Lisa Saladin, Ph.D., interim
chair, Department of Rehabilitation Sciences; and occupational
therapist Michelle Woodbury, Ph.D., adjunct assistant professor of
Under faculty supervision, occupational and physical therapy students
serve as camp counselors, making it part of the their clinical
training. Only seven children at a time are enrolled in the camp
allowing a staffing ratio of two students per camper. The students
design activities to encourage social interaction and motor skills
during individual and group playtime.
“What we did was take the UAB model and put children in a camp in
which they work with each other,” Coker said. “Through camp, the
children are intrinsically motivated, taping into their inner drive to
play and succeed.”
Currently, the camp is offered at no cost to families and is funded
through a $1,500 grant from the Coastal Community Foundation, as well
as a $39,000 internal grant from MUSC’s Department of Rehabilitation
Sciences. The camp is an Internal Review Board-approved, two-year
study, and an article on the effects of this modified
constraint-induced movement program is currently under review.
The camp takes place in CHP’s research building on President Street
where children are first assessed in the motion analysis laboratory.
The camp is designed and equipped to include interactive, practical
child-learning tools, which carry themes such as Western Day, Jungle
Day or Pirate Day to engage children’s interest. They play
theme-oriented games and activities along with performing
“The activities are set up to encourage the child to use the weaker arm
or leg in order to strengthen motor responses and skills,” Coker said.
“The constraint we use is a puppet-covered splint, which is
incorporated into the overall camp theme.”
The children, who are seen every six months after camp, show
significant, enduring gains in motor skills and posture, Coker said.
For example, children are better able to kick a ball, ride a tricycle,
and dress themselves with improved use of their weaker arm or leg.
“We have seen these children improve posture, symmetry, balance and
adaptive function,” Coker said.
Since it began, Camp Hand to Hands has treated 50 children, making it
the nation’s second largest program behind UAB’s. The MUSC program also
is becoming increasingly replicated by treatment centers including
those at the University of North Carolina, Shriner’s Hospital and the
Myers Center for Children in Greenville, the University of Michigan,
and Kennedy Krieger, which is part of Johns Hopkins University.
Friday, May 9, 2008
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