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What Is Environmental Press With Pediatric Constraint Induced Movement Therapy?

Mary Rebekah Trucks, OTR/L, Dory Ainsworth Wallace, MS, OTR/L

June 20, 2016

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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.

mary rebekah trucks

Mary Rebekah Trucks, OTR/L

Mary Rebekah Trucks, MS, OTR/L is a senior occupational therapist and research faculty with the Neuromotor Research Clinic at the Virginia Tech Carilion Research Institute.  She has 15 years of clinical and research experience in Pediatric Constraint Induced Movement Therapy.  She has assisted in developing the clinical applications of ACQUIREc and Pediatric CI Therapy and has trained numerous therapists in this approach.  She has presented at numerous State and National Occupational Therapy Association meetings. 
dory ainsworth wallace

Dory Ainsworth Wallace, MS, OTR/L

Dory Wallace, MS, OTR/L is a senior occupational therapist and research faculty with the Neuromotor Research Clinic at the Virginia Tech Carilion Research Institute.  She has 12 years of clinical experience in Pediatric Constraint Induced Movement Therapy, school based occupational therapy, and skilled nursing.  She assisted in research and developing various clinical applications of the ACQUIREc model of Pediatric Constraint Induced Therapy.  She has presented at State and National Occupational Therapy Association meetings.

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