Constraint-induced Movement Therapy - Limitations To Implementation

Limitations To Implementation

Presently, constraint-induced movement therapy (CIMT) has not been incorporated as part of standard practice for the rehabilitation of the hemiplegic upper extremity. Concerns have been raised over the generalizability of the results obtained from research, as selection criteria for CIMT research has excluded patients with a moderate or more severe stroke, due to balance problems, serious cognitive deficits, and global aphasia, which may reduce understanding of safety instructions and interfere with a patient’s ability to communicate difficulties.

The cost of resources needed to conduct CIMT treatment protocol are high. Costs are generated due to the intensity of therapy required for CIMT, as participants typically receive up to 6 hours of one-on-one therapy at least 5 days per week for 2 weeks. CIMT can be prohibitively expensive for patients paying out-of-pocket or for publicly funded health care systems attempting to make this program available to all eligible stroke survivors.

Therapist apprehension directed at safety issues with constraint use, lack of facilities, the cost of providing one-on-one therapy sessions, and the opportunity costs associated with the therapist’s inability to see and treat other patients during that time has contributed to the resistance of adopting the CIMT protocol.

The patient’s ability to tolerate the intensity and duration of the therapy sessions is a limiting factor to protocol adoption. Stroke patients have commonly expressed the length of time wearing the constraint and time consuming hours of therapy as reasons they wish not to participate.

While the CIMT protocol results in improved function in its target population, it is unknown whether the combination of constraint and therapy is necessary to achieve the outcome seen or whether the benefit is due to exposure to high-intensity, task-specific activities focused on the use of the more affected limb.