Constraint Induced Movement Therapy

The term Constraint-Induced Movement Therapy (CIMT) describes a package of interventions designed to decrease the impact of a stroke on the upper-limb (UL) function of some stroke survivors. It is a behavioural approach to neurorehabilitation based on "Learned- Nonuse".

CIMT is typically performed for individuals following a cerebrovascular accident (CVA) as between 30-66% of CVA survivors will experience some functional loss in their impaired limb.Furthermore, CIMT has also been performed for individuals with cerebral palsy (CP), traumatic brain injury (TBI) and multiple sclerosis (MS).

The aim of CIMT is to improve and increase the use of the more affected extremity while restricting the use of the less affected arm.

History

The term is derived from the studies of non-human primates in which somatosensory de-afferentation of a single forelimb, after which the animal fails to use that limb. Originally developed by Dr Edward Taub who demonstrated that monkeys with a surgical de-afferentation (i.e. somatic sensation was abolished) of a forelimb, ceased using the affected extremity. Through failed attempts to use the de-afferented forelimb, the monkeys developed compensation methods to avoid using the affected limb, that is, they effectively learned not to use their affected extremity termed learned non-use.

Indication

Participants who have suffered a stroke require some hand function, high motivation, minimal cognitive dysfunction, adequate balance and adequate walking ability while wearing the restraint to be eligible to participate in CIMT interventions.

The minimum motor criterion for inclusion into therapy is

• 10° wrist extension

• 10° thumb abduction

• 10° finger extension

Clinical Intervention

• Participants wear a mitt on the less-affected arm 90% of their waking hours.

• Perform repetitive task-oriented training with the affected arm 6-7 hours per day.

• Perform for 10 - 15 consecutive weekdays.

There are 3 major components;

1. Shaping is a training method in which a motor task is gradually made more difficult. Shaping programs are individualized consisting of 10-15 tasks selected primarily from a basic battery of tasks. Each task is usually performed in a set of 10-30 sec trials. At the end of each set of 10 trials, the task is changes. Only one shaping parameter is changed at a time. It requires constant therapist involvement.

2. Task practice is repetitive practice of individual functional tasks that takes roughly 15-20mins.Rest is provided as required. Encouragement is given on an infrequent basis (i.e. every 5 mins) with feedback at end of the task as well about how they performed.Requires less therapist involvement.
   

3. Package of behavioural techniques is designed to transfer gains from the clinic to daily life. Includes a behavioural contract that identifies tasks that the participant will attempt to perform. Furthermore, this allows for the identification of barriers and problem solving to overcome these obstacles. The daily administration of the motor activity log promotes adherence.

After a stroke, regaining strength and function in your weaker arm (the side weakened by the stroke) can be challenging. Constraint-Induced Movement Therapy (CIMT) involves intensive training of the weaker arm while restricting the use of the stronger arm. Specifically, the use of the stronger arm is restricted by the use of a mitten or a sling for much of each day. The idea is to encourage you to use your weaker hand to do daily activities. This therapy has been studied by high quality research studies and has been found beneficial for arm function in some patients- especially those who already have some use of their arm and hand.

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