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.
