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CLINICAL BOTTOM LINE Commentary on “Effect of Body-Scaled Information on Reaching in Children With Hemiplegic Cerebral Palsy: A Pilot Study”

“How should I apply this information?” As therapeutic interventions move toward more functional approaches, changing the constraints of a task and/or environment during movement practice is emphasized. This study examined parameters of the “fit” of a child’s movement to the constraints of the environment. It is important that both the task and the environment match the movement parameters needed for successful task completion. One can guess or experiment as to which task constraints will result in successful task completion, or one can use specific constraints that will result in successful task performance. This study represents an important start identifying the critical ratio that determines shifting between unimanual or bimanual movement patterns. This knowledge can be used to promote consistent unimanual or bimanual practice of reach to grasp activities in a therapy session without verbal directions or prompts. It is important to remember that exploratory movement behaviors and practice lead to enhanced task performance. Thus, a “just-right challenge” should allow for a range of practice opportunities both above and below the critical ratio to provide opportunity for such problem solving. This approach may optimize transfer from the clinic into real-world settings. “What should I be mindful of in applying this information?” Therapists should also be mindful of the type of movement that a child is asked to practice during a therapy session. A movement should be evaluated in relation to transfer from the therapy session to a functional movement to be performed in a real-world setting. This can be referred to as practice specificity. Thus, bimanual practice should be necessary to improve bimanual performance and unimanual practice for improvement of unimanual performance in real-world tasks.

Jeanne Charles, PT, MSW, PhD University of New England, Portland, Maine Andrew M. Gordon, PhD Teachers College, Columbia University, New York, New York The authors declare no conflicts of interest. DOI: 10.1097/PEP.0000000000000009

Pediatric Physical Therapy

Reaching in Children With Hemiplegia

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Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins and the Section on Pediatrics of the American Physical Therapy Association. Unauthorized reproduction of this article is prohibited.

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