Hybrid Telehealth Pediatric Constraint Induced Movement Therapy Compared to In-person Intervention: A Case Series


  • Teressa Garcia Reidy Kennedy Krieger Institute
  • Nicole Whiston Andrejow Kennedy Krieger Institute
  • Erin Naber Kennedy Krieger Institute
  • Joan Carney Kennedy Krieger Institute




Contraint Induced Movement Therapy, Hemiplegia, Hybrid intervention protocol, Pediatrics


Constraint induced movement therapy is an established, evidence-based intervention for children with hemiplegia. This case series describes the feasibility and clinical opportunities of using a hybrid telehealth and onsite model to deliver pediatric constraint induced movement therapy during the COVID-19 pandemic. These cases support that a hybrid model had a similar effect on upper extremity improvement compared to a traditional, in-person model and may be an option when access to in-person care is not available.


Author Biographies

Nicole Whiston Andrejow , Kennedy Krieger Institute

Occupational Therapist III, Specialized Transition Program

Erin Naber, Kennedy Krieger Institute

Senior Physical Therapist, Specialized Transition Program, Kennedy Krieger Institute

Joan Carney , Kennedy Krieger Institute

Assistant Vice President, Clinical Programs


Baker, A., Niles, N., Kysh, L., & Sargent, B. (2022). Effect of motor intervention for infants and toddlers with cerebral palsy: A systematic review and meta-analysis. Pediatric Physical Therapy, 34(3), 297-307. https://doi.org/10.1097/PEP.0000000000000914

Beckers, L. W., Geijen, M. M., Kleijnen, J., Rameckers, E. A., Schnackers, M. L., Smeets, R. J., & Janssen-Potten, Y. J. (2020). Feasibility and effectiveness of home-based therapy programmes for children with cerebral palsy: A systematic review. BMJ Open, 10(10), e035454. https://doi.org/10.1136/bmjopen-2019-035454

DeMatteo, C., Law, M., Russell, D., Pollock, N., Rosenbaum, P., & Walter, S. (1993). The reliability and validity of the Quality of Upper Extremity Skills Test. Physical & Occupational Therapy in Pediatrics, 13(2), 1-18.

Greaves, S., Imms, C., Dodd, K., & Krumlinde‐Sundholm, L. (2013). Development of the Mini-Assisting Hand Assessment: Evidence for content and internal scale validity. Developmental Medicine & Child Neurology, 55(11), 1030-1037. https://doi.org/10.1111/dmcn.12212

Hall, J. B., Luechtefeld, J. T., & Woods, M. L. (2022). Pediatric physical therapists' perceptions of telehealth continuation post-pandemic: A thematic analysis of open-ended survey responses. Pediatric Physical Therapy, 34(3), 353-360. https://doi.org/10.1097/PEP.0000000000000908

Hanft, B. E., Rush, D. D., & Shelden, M. L. L. (2004). Coaching families and colleagues in early childhood. Baltimore, MD: Brookes Publishing Company

Knapp, C., Cline, B., Smith, A., Barlow, M., & Schoellig, S. (2023). Occupational Therapy and COVID-19: How the Transition to Telehealth Has Affected Outcomes for Children: A Systematic Review. Journal of Occupational Therapy, Schools, & Early Intervention, 1-11. https://doi.org/10.1080/19411243.2023.2203421

Krumlinde-Sundholm, L., Holmefur, M., & Eliasson, A. C. (2007). Assisting Hand Assessment manual, research version 4.4. Stockholm: Karolinska Institute, Neuropediatric Research Unit, Astrid Lindgren Children's Hospital.

Krumlinde‐Sundholm, L. (2012). Reporting outcomes of the Assisting Hand Assessment: What scale should be used? Developmental Medicine & Child Neurology, 54(9), 807-808. https://doi.org/10.1111/j.1469-8749.2012.04361.x

Novak, I., Morgan, C., Fahey, M., Finch-Edmondson, M., Galea, C., Hines, A., . . . Badawi, N. (2020). State of the evidence traffic lights 2019: Systematic review of interventions for preventing and treating children with cerebral palsy. Current Neurology and Neuroscience Reports, 20, 2. https://doi.org/10.1007/s11910-020-1022-z

Önal, G., Güney, G., Gün, F., & Huri, M. (2021). Telehealth in paediatric occupational therapy: a scoping review. International Journal of Therapy and Rehabilitation, 28(7), 1-16. https://doi.org/10.12968/ijtr.2020.0070

Ownsworth, T., Arnautovska, U., Beadle, E., Shum, D. H., & Moyle, W. (2018). Efficacy of telerehabilitation for adults with traumatic brain injury: A systematic review. Journal of Head Trauma Rehabilitation, 33(4), E33-E46. https://doi.org/10.1097/HTR.0000000000000350

Pickett, T. C., Davis, S. B., Fritz, S. L., Malcolm, M. P., Ketterson, T. U., Light, K. E., & Glueckauf, R. L. (2007). Telehealth and Constraint-Induced Movement Therapy (CIMT): An intensive case study approach. Clinical Gerontologist, 31(1), 5-20.

Pietruszewski, L., Burkhardt, S., Yoder, P. J., Heathcock, J., Lewandowski, D. J., & Maitre, N. L. (2020). Protocol and feasibility-randomized trial of telehealth delivery for a multicomponent upper extremity intervention in infants with asymmetric cerebral palsy. Child Neurology Open, 7. https://doi.org/10.1177/2329048X20946214

Ramey, S. L., DeLuca, S. C., Stevenson, R. D., Conaway, M., Darragh, A. R., & Lo, W. (2021). Constraint-induced movement therapy for cerebral palsy: A randomized trial. Pediatrics, 148(5), e2020033878. https://doi.org/10.1542/peds.2020-033878

Reidy, T. G., Naber, E., Viguers, E., Allison, K., Brady, K., Carney, J., Salario, C., & Pidcock, F. (2012). Outcomes of a clinic-based pediatric constraint-induced movement therapy program. Physical & Occupational Therapy in Pediatrics, 32(4), 355-367. https://doi.org/10.3109/01942638.2012.694991

Reidy, T. G., Carney, J., Whiston, N., & Naber, E. (2017). Infant constraint induced movement therapy: Lessons learned from clinical implementation. Journal of Pediatric Rehabilitation Medicine, 10(1), 61–67. https://doi-org.proxy1.library.jhu.edu/10.3233/prm-170411

Rush, D. D., & Shelden, M. L. L. (2011). The Early Childhood Coaching Handbook. Baltimore, MD: Brookes Publishing Company.

Shierk, A., Roberts, H., Dubberly, K., Clegg, N. J., Fagan, M., Baldwin, D., ... Delgado, M. R. (2021). Therapy together: A caregiver led constraint induced movement therapy program for preschool aged children utilizing a virtual environment due to COVID 19. Journal of Occupational Therapy, Schools, & Early Intervention, 16(1), 39-50. https://doi.org/10.1080/19411243.2021.2003738

Smegal, L.F., Vedmurthy, P., Ryan, M., Eagen, M., Andrejow, N.W., Sweeney, K., Reidy, T.G., Yeom, S., Lin, D.D., Suskauer, S.J., Kalb, L.G. & Comi, A. M. (2023). Cannabidiol treatment for neurological, cognitive, and psychiatric symptoms in Sturge-Weber Syndrome. Pediatric Neurology, 139, 24-34. https://doi.org/10.1016/j.pediatrneurol.2022.10.014

Smith, M. A., & Tomita, M. R. (2020). Combined effects of telehealth and modified constraint-induced movement therapy for individuals with chronic hemiparesis. International Journal of Telerehabilitation, 12(1), 51-62. https://doi.org/10.5195/ijt.2020.6300

Tanner, K., Bican, R., Boster, J., Christensen, C., Coffman, C., Fallieras, K., ... Marrie, J. (2020). Feasibility and acceptability of clinical pediatric telerehabilitation services. International Journal of Telerehabilitation, 12(2), 43-52. https://doi.org.10.5195/ijt.2020.6336

Tamboosi, M. E., Al-Khathami, S. S., & El-Shamy, S. M. (2021). The effectiveness of tele-rehabilitation on improvement of daily living activities in children with cerebral palsy: Narrative review. Bulletin of Faculty of Physical Therapy, 26(1), 1-12. https://doi.org.10.1186/s43161-021-00055-7

Tenforde, A. S., Borgstrom, H., Polich, G., Steere, H., Davis, I. S., Cotton, K., ... Silver, J. K. (2020). Outpatient physical, occupational, and speech therapy synchronous telemedicine: A survey study of patient satisfaction with virtual visits during the COVID-19 pandemic. American Journal of Physical Medicine & Rehabilitation, 99(11), 977-981. https://doi.org.10.1097/PHM.0000000000001571

Trottier, N., Hurtubise, K., Zischke, C., & Camden, C. (2022). Pediatric assessments for preschool children in digital physical therapy practice: Results from a scoping review. Pediatric Physical Therapy, 34(3), 362-373. https://doi.org.10.1097/PEP.0000000000000915

Verhaegh, A. P., Nuijen, N. B., Aarts, P. B., Nijhuis-van der Sanden, M. W., Willemsen, M. A., Groen, B. E., & Vriezekolk, J. E. (2022). Parents’ experiences with a home-based upper limb training program using a video coaching approach for infants and toddlers with unilateral cerebral palsy: a qualitative interview study. BMC Pediatrics, 22(1), 380. https://doi.org.10.1186/s12887-022-03432-w

Walker, C., Shierk, A., & Roberts, H. (2022). Constraint induced movement therapy in infants and toddlers with hemiplegic cerebral palsy: A scoping review. Occupational Therapy In Health Care, 36(1), 29-45. https://doi.org.10.1080/07380577.2021.1953206

Whiston, N., Reidy, T. G., Naber, E., Carney, J., & Salorio, C. (2019). Modifying constraint induced movement therapy for diverse populations. Journal of Interprofessional Education & Practice, 15, 88-93. https://doi.org.10.1016/j.xjep.2019.02.005




How to Cite

Garcia Reidy, T., Whiston Andrejow, N., Naber, E., & Carney, J. (2023). Hybrid Telehealth Pediatric Constraint Induced Movement Therapy Compared to In-person Intervention: A Case Series. International Journal of Telerehabilitation, 15(2). https://doi.org/10.5195/ijt.2023.6567



Occupational Therapy Telehealth