Introduction/Rationale: Pediatric Constraint-Induced Movement Therapy (PCIMT) is a leading, evidence-based approach which improves function in children with hemiplegic cerebral palsy (CP), but there are barriers to implementing intensive therapies in countries with limited resources.
Objective: To use implementation science strategies to train therapists to successfully implement PCIMT in a country with workforce challenges.
Methods/Approach: The ACQUIRE translational framework was used to build capacity for PCIMT in Trinidad and Tobago using online didactic education, hands-on training, and remote mentoring by experienced CIMT therapists. The collaboration led to the development of a contextually relevant intensive PCIMT model (total dosage=60-80hrs). Following IRB approval and parental consent, the model was delivered to a four-year old with right-sided hemiplegia. Child was assessed across three time points using the Goal Attainment Scale (GAS), Quality Upper Extremity Skills Test (QUEST), and the Pediatric Motor Activity Log (PMAL).
Results/Practice Implications: PCIMT program was successfully piloted by the Trinidad and Tobago OTs who maintained fidelity to the principles of PCIMT. Child met 5/5 GAS goals and had clinically significant improvements on QUEST Dissociated Movement (baseline-72.4, pre-72.4, post-79.4; Δ=6 points) and Grasp (baseline-66.7, pre-66.7, post- 74.4; Δ=8 points) and PMAL (How Well: baseline-46, pre-45, post-50; Δ=5 points; How Often: baseline-47, pre-42, post-50; Δ=8 points) assessments. At 6-months post-treatment, parents reported the child was able to dress himself independently with 2-hands.
Conclusion / Significance to the Occupational Therapy Profession: This case highlights the ability to use implementation science to translate and deliver contextually relevant intensive therapy abroad in a setting with workforce challenges. It builds upon the World Health Organization Rehabilitation 2030 initiative to scale up rehabilitation in the most needed areas