Monday, January 23rd, 2017
What is it?
Constraint-induced movement therapy (CI, CIT, or CIMT) is a form of rehabilitation therapy that improves upper extremity function in stroke and other neurological injuries by increasing the use of their affected upper limb. The focus of CIMT is to combine restraint of the unaffected limb and intensive use of the affected limb. Types of restraints include a sling, a splint, a sling combined with a resting hand splint, a half glove, and a mitt. Determination of the type of restraint used for therapy depends on the required level of safety vs. intensity of therapy.
Constraint typically consists of placing a mitt on the unaffected hand or a sling or splint on the unaffected arm, forcing the use of the affected limb with the goal of promoting purposeful movements when performing functional tasks. The CIMT protocol contains three components: (1) intensive graded practice of the paretic upper limb aimed at enhancing task-specific use of the affected limb for up to 6 hours a day for 2 weeks; (2) constraining of the non-paretic upper limb with a mitt to promote the use of the more impaired limb during 90% of the waking hours; and (3) adherence-enhancing behavioral methods designed to transfer the gains obtained in the clinical setting or laboratory to the patients’ real-world environment.
CIMT has been investigated in 51 RCTs, including 1784 patients with adult stroke, but only 15 trials included patients within the first three months post stroke. The meta-analyses show that CIMT has a clinically meaningful impact on patient’s outcomes for arm-hand activities, self-reported amount and quality of arm-hand use in daily life, and basic ADL, making CIMT one of the most effective interventions for the upper paretic limb post stroke.
Constraint-induced movement therapy (CIMT) coupled with intensive and varied exercise training has proven to be effective in reducing spasticity and increasing function of the hemiplegic upper extremity in chronic stroke patients. The effects of constraint-induced movement therapy has been found to improve movements that not only remain stable for months after the completion of therapy, but translate well to improvements of everyday functional task.
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;
Unfortunately, only approximately 20% of the stroke population will meet the above criteria. The vast majority of stroke survivors, head injury and incomplete spinal cord injury patients do not exhibit sufficient wrist and/or finger extension to qualify for CIMT. These patients are therefore unable to benefit from the latest advances in neurorehabilitation.
Mechanical devices that assist patients with wrist and finger extension allow for repetitive functional training. Some of these devices have the biomechanical advantage in allowing prehension / grasp and release activities for individuals with moderate to severe hemiparesis. In addition to widening the net of CIMT patients through bracing and functional orthoses, it is essential that clients engage in additional evidence-based treatment interventions to maximize results.