Types of Constraint
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 or triangular bandage, 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. Some restraints restrict the wearer from using their hand and wrist, though allow use of their non-involved upper extremity for protection by extension of their arm in case of loss of balance or falls. However, restraints that allow some use of the non-involved extremity will result in less intensive practice because the non-involved arm can still be used in complete tasks. 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 use of the affected limb is called shaping. Typically, CIMT involves restraining the unaffected arm in patients with hemiparetic stroke or hemiparetic cerebral palsy (HCP) for 90% of waking hours while engaging the affected limb in a range of everyday activities However, studies have varied on hours of restraint per day and length of therapy. More specifically, CIMT involves the person performing supervised structured tasks with the affected limb 6 hours a day for 10 days over a 14 day period, in addition to wearing the restrictive mitt or sling for 90% of waking hours. One form of modified constraint induced movement therapy that has been found to be effective in improving motor control strategy during goal-directed reaching involved massed practice of the affected limb 2 hours a day for 10 days, in addition to wearing the restrictive mitt or sling for 6 hours a day for 2–3 weeks. Practitioners say that stroke victims disabled for many years have recovered the use of their limbs using CIMT. However, it has been shown that receiving CIMT early on (3–9 months post-stroke) will result in greater functional gains than receiving delayed treatment (15–21 months post-stroke). Through research, two key factors of CIMT have emerged that relate to the effectiveness of regaining function. First is that CIMT needs to include concentrated and repetitive practice of the affected limb. Second, the other arm or hand needs to be constrained at least 90 percent of waking hours.
Read more about this topic: Constraint-induced Movement Therapy
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