Sapna Chakraborty, post professional occupational therapy student, has been recognized by her local newspaper for her work with ACQUIRE Therapy. The article in full appears below.
Therapy brings child success
An 8-year-old girl with cerebral palsy can now pick up items and feed herself thanks a program available at CoxHealth and St. John's systems.
Juliana Goodwin
News-Leader
There have been many triumphs in Jodelyn Belew's life.
And the 8-year-old owes some of those victories to ACQUIRE therapy.
Her parents, Laurie and Paul Belew, have been advocates of this therapy for years, even when they couldn't find anyone offering it locally.
Now ACQUIRE therapy is available through St. John's and CoxHealth Systems. Sapna Chakraborty (shown left), occupational therapist at CoxHealth's Meyer Center, was recently trained at the Pediatric Neuromotor Research Clinic in Alabama, where this therapy in children is being administered.
Laurie Belew believes more children in the Ozarks could benefit from ACQUIRE. This is Jodelyn's sixth round with ACQUIRE.
A brain abscess left Jodelyn with cerebral palsy when she was 6 months old, primarily affecting the left side of her body. The News-Leader first profiled Jodelyn when she was 4. At that time, she could not pick up a paper clip and struggled to feed herself.
At age 6, the News-Leader followed her progress. At that time her family was trying to raise money to send an occupational therapist to the Alabama clinic to train in ACQUIRE, and was collecting cans to raise funds. Shortly after that story ran, CoxHealth decided to send Chakraborty, who went in December.
Jodelyn has shown marked improvements each time she's undergone the therapy, which lasts three weeks. She can now pick up a paper clip, feed herself, pick up a soda can, use an adapted device to type on a keyboard, circle answers on a test, and turn and extend her arm more. Accomplishments that were elusive a few years ago.
What is ACQUIRE?
Behavioral neuroscientist Edward Taub and colleagues at the University of Alabama-Birmingham pioneered the therapy, which was initially used with stroke patients and adults with traumatic brain injury.
It was piloted in children in the late 1990s and is often used on children with cerebral palsy, which is a general term for a brain injury affecting movements and muscle coordination.
In a nutshell, here's how it works: The child's stronger arm is restrained in a cast and he or she goes through six hours of daily therapy on the weaker arm to produce changes in motor behavior and the brain. The weaker arm is trained in various developmentally appropriate tasks.
Although this type of therapy was originally used with adults, children appear to be more promising subjects."The younger brain has more neuroplasticity, so it should work better for kids," says Chakraborty.
Whether the therapy is used with a child with cerebral palsy or with a stroke victim, what happens is the patients begin to rely on their dominant arm and use their weaker limb less, a process called "learned nonuse," says Stacey Anderson, occupational therapist with St. John's who has administered this therapy.
"If you don't use it, it becomes weaker. If you don't use an extremity you use that part of the brain even less," Anderson says. The arm works but the patient neglects it. In addition to increasing awareness of the limb, researchers found that the part of the brain which produces movement in the limb actually increases in size during therapy. What sets ACQUIRE apart from traditional occupational therapy is its intensity and mass repetition, which promotes neuro-motor changes, says Chakraborty.
History of ACQUIRE
ACQUIRE therapy was formerly called constraint induced movement therapy (CI therapy), and it retains that name when used on adults. The name was changed in pediatrics to better reflect what it accomplishes, says Stephanie Deluca, director of the Pediatric Neuromotor Research Clinic in Alabama.
The acronym stands for: Acquisition of new motor skills through; Continuous practice and shaping to produce; Quality movement of the Upper extremity through Intensive therapy and Reinforcement in Everyday patterns and places. The difficulty in replicating this therapy outside the lab is the intensity.
During her three weeks of ACQUIRE, Jodelyn meets with her physical therapists several days a week and also works with a therapist in school. At home, her parents work with her around the clock.
"We don't see them that many hours a day so it becomes the family or patient's responsibility to work on it at home," Anderson says. Knowing this, Deluca and colleagues have a study under way to compare the effectiveness of this therapy if it is administered three hours a day instead of six. They are also exploring the idea of having therapy administered by paraprofessionals, Deluca says.
There's even been talk of training parents, but Deluca says that is one of the least likely options. Not only would it be exhausting for parents, but it would change the parent-child relationship."We don't want the child to see the parent always as a therapist," Deluca says. The therapy is so time- consuming most parents couldn't do it, she adds. But she wants to find a way to make ACQUIRE more widely available.
"We can never see it as unrealistic because if we do, it will deprive the children of it who need an efficacious therapy that is too beneficial to ignore."We have to find a way to make it realistic," Deluca says.
At the end of week three, Chakraborty measures Jodelyn's improvements with a series of tests. The training in Alabama has given her a "better eye" as she works with Jodelyn."She's doing really good in elbow extension. Her grasp has shown tremendous improvement," Chakraborty says.
Jodelyn pushes a weight, flips over a note card, turns a key in a lock, and then gets on all fours. Chakraborty explains this test is to "see how actively this arm participates when the body is off balance."While Jodelyn has made great strides with ACQUIRE, she's also had numerous surgeries and does continuous therapy, so her progress is due to more than this particular regiment. But Laurie Belew knows this has made a difference, calling the improvements "tremendous."
Chakraborty believes other children could benefit from ACQUIRE, but it's not for everyone."The children with uncontrollable seizures, unstable medical conditions and severe behavior issues, which will make it hard for an individual to take part in the program," Chakraborty says.
Even Jodelyn noticed improvements and talked about how she could eat cereal or play Wii.
This time around, she tackled her therapy with gusto."Her attitude was so much more gung-ho, Laurie Belew says."She was just ready."
Juliana Goodwin • News-Leader • May 4, 2009
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