Question
What is environmental press with pediatric constraint induced movement therapy?
Answer
Environmental press is not enough. I do not think these kids will just use their hand based on an activity. I think it requires the direction of the therapist to give specific cues and then change specific cues based on what the child can do.
As a brief aside, we are working in research with babies. Part of that is that they do not have a cast on their weaker arm and hand. When I did treatment and I gave the child a toy and just let them explore with the toy, inevitably, their stronger arm and hand came in and did more than the weaker arm and hand until I facilitated and gave them specific directions and cues for what to do with that hand. I do not know how many of you are familiar with the Assisting Hand Assessment, but there is a portion in there that has a bottle with a rounded bottom. The child is supposed to take the top off of the bottle and obviously, a bottle with a rounded bottom is not going to stand up straight. I have seen children literally do it one handed and just take the bottle and turn it on its top. Then the bottle is standing up straight.
Again, a long answer to say, I do not think environmental press is enough. I think you have to provide the specific cues and the shaping within the repetition.
Continued and its subsidiaries provide professional education authored by qualified Subject Matter Experts for continuing education purposes. These materials are intended for educational purposes and do not constitute medical advice or a substitute for individual clinical judgment. Continued is not a clinical healthcare provider; the licensed professional is solely responsible for ensuring that the application of any techniques or information presented is within their legal scope of practice and jurisdictional requirements.
