Constraint-induced Movement Therapy - Application of CIMT

Application of CIMT

CIMT may be applicable to up to 75 percent of stroke patients, although the amount of improvement produced by CIMT appears to diminish as the initial motor ability of the patient decreases. CIMT has been shown to be an effective means of stroke rehabilitation regardless of the level of initial motor ability, amount of chronicity, amount of prior therapy, side of hemiparesis, or infarct location. This suggests that CIMT-induced plasticity may work irrespective of the pathways in the damaged motor network. Although, due to the intensity of this treatment, patients who have suffered profound upper extremity paralysis from their condition are normally not eligible for constraint-induced upper extremity training. A consistent exclusion criterion for CIMT has been the inability to perform voluntary wrist and finger extension in the involved hand.

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. Siebers, Oberg and Skargren conducted a study in 2010 involving patients between 6 months to 10 years post stroke. The unaffected upper limb of each subject was constrained using a restricting position belt for 90% of waking hours, 7 days a week, for 2 weeks and they were each assigned individualized, upper extremity exercise programs by a physiotherapist and occupational therapist to be completed 5 days a week in an outpatient rehabilitation clinic. Reduced spasticity and improved function were measured following the 2-week treatment block and improvements persisted 6 months later. Therefore, chronic hemiplegia can significantly benefit from CIMT with reductions in disuse complications, spasticity and improved function with increased use of the hemiplegic limb in activities of daily life.

The effects of constraint-induced movement therapy have 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. This can be done by including the “transfer package” of CIMT during treatment, in which the physiotherapist applies various strategies to help the patient adhere to the requirements of CIMT outside the clinical setting. These strategies may include: 1. Monitoring, which requires patients to document their performance of target behaviours; 2. Problem solving, in which patients create solutions and identify outcomes to potential obstacles; and 3. Behavioural contracting, which involves getting patients to identify the components and methods of carrying out normal behaviors. Gauthier and colleagues demonstrated the importance of the “transfer package” by comparing outcome measure scores of post-stroke patients who participated in CIMT with and without the “transfer package”. Those whose treatment included the “transfer package” had a significantly higher score in the Quality of Movement scale of the Motor Activity Log than those whose treatment did not include the “transfer package”, indicating that the former group used their affected arm more in real life situations.