Constraint-induced movement therapy
Encyclopedia
Constraint-induced movement therapy (CI or CIMT) is a form of rehabilitation therapy that improves upper extremity function in stroke
and other Central Nervous System damage victims 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. 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.
As a result of the patient engaging in repetitive exercises with the affected limb, the brain grows new neural pathways
. This change in the brain is referred to as cortical reorganization. One study by Deluca et al. showed that using Transcranial Magnetic Stimulation
(TMS) that the excitable cortex of the affected cortex in adults patients with HCP doubled in size after 12 days of therapy. Recently, the possible benefits of cortical reorganization has led to studies of CIMT on children because neuroplasticity is even greater among children than adults. Particular interest is growing in CIMT for children who have cerebral palsy
where one arm is more affected than the other.
CI was developed by Dr. Edward Taub
of the University of Alabama at Birmingham
. Taub argues that, after a stroke, the patient stops using the affected limb because they are discouraged by the difficulty. As a result, a process that Taub calls "learned non-use" sets in, furthering the deterioration. Learned non-use is a type of negative feedback. Individuals are unable to move their affected limb or the movements are inefficient and clumsy and in response to this a suppression of movement occurs. It is this process that CIMT seeks to reverse.The American Stroke Association has written that Taub's therapy is "at the forefront of a revolution" in what is regarded possible in terms of recovery for stroke survivors.
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.
Stroke
A stroke, previously known medically as a cerebrovascular accident , is the rapidly developing loss of brain function due to disturbance in the blood supply to the brain. This can be due to ischemia caused by blockage , or a hemorrhage...
and other Central Nervous System damage victims 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. 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
Stroke
A stroke, previously known medically as a cerebrovascular accident , is the rapidly developing loss of brain function due to disturbance in the blood supply to the brain. This can be due to ischemia caused by blockage , or a hemorrhage...
or hemiparetic cerebral palsy
Cerebral palsy
Cerebral palsy is an umbrella term encompassing a group of non-progressive, non-contagious motor conditions that cause physical disability in human development, chiefly in the various areas of body movement....
(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
Motor control
Motor control are information processing related activities carried out by the central nervous system that organize the musculoskeletal system to create coordinated movements and skilled actions...
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.
As a result of the patient engaging in repetitive exercises with the affected limb, the brain grows new neural pathways
Neuroplasticity
Neuroplasticity is a non-specific neuroscience term referring to the ability of the brain and nervous system in all species to change structurally and functionally as a result of input from the environment. Plasticity occurs on a variety of levels, ranging from cellular changes involved in...
. This change in the brain is referred to as cortical reorganization. One study by Deluca et al. showed that using Transcranial Magnetic Stimulation
Transcranial magnetic stimulation
Transcranial magnetic stimulation is a noninvasive method to cause depolarization or hyperpolarization in the neurons of the brain...
(TMS) that the excitable cortex of the affected cortex in adults patients with HCP doubled in size after 12 days of therapy. Recently, the possible benefits of cortical reorganization has led to studies of CIMT on children because neuroplasticity is even greater among children than adults. Particular interest is growing in CIMT for children who have cerebral palsy
Cerebral palsy
Cerebral palsy is an umbrella term encompassing a group of non-progressive, non-contagious motor conditions that cause physical disability in human development, chiefly in the various areas of body movement....
where one arm is more affected than the other.
CI was developed by Dr. Edward Taub
Edward Taub
Edward Taub is a behavioral neuroscientist on faculty at the University of Alabama at Birmingham. He is best known for his involvement in the Silver Spring monkeys case and for making major breakthroughs in the area of neuroplasticity and discovering/developing constraint-induced movement therapy;...
of the University of Alabama at Birmingham
University of Alabama at Birmingham
The University of Alabama at Birmingham is a public university in Birmingham in the U.S. state of Alabama. Developing from an extension center established in 1936, the institution became an autonomous institution in 1969 and is today one of three institutions in the University of Alabama System...
. Taub argues that, after a stroke, the patient stops using the affected limb because they are discouraged by the difficulty. As a result, a process that Taub calls "learned non-use" sets in, furthering the deterioration. Learned non-use is a type of negative feedback. Individuals are unable to move their affected limb or the movements are inefficient and clumsy and in response to this a suppression of movement occurs. It is this process that CIMT seeks to reverse.The American Stroke Association has written that Taub's therapy is "at the forefront of a revolution" in what is regarded possible in terms of recovery for stroke survivors.
Constraint-induced movement therapy (CIMT) coupled with intensive and varied exercise training has proven to be effective in reducing spasticity
Spasticity
Spasticity is a feature of altered skeletal muscle performance in muscle tone involving hypertonia, which is also referred to as an unusual "tightness" of muscles...
and increasing function of the hemiplegic upper extremity in chronic
Chronic
Chronic may refer to:* Chronic , a disease that is long-lasting and reoccurring.* Chronic toxicity, a substance with toxic effects after continuous or repeated exposure* The Chronic, a 1992 album by Dr. Dre...
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.