Constraint-Induced Movement Therapy- upper extremity
Constraint-Induced Movement Therapy (CIMT) consists of a set of rehabilitation techniques designed to reduce functional problems in the most affected upper extremity of clients with stroke. This therapy involves constraining movements of the less-affected arm, usually with a sling or mitt for 90% of waking hours, while intensively inducing the use of the more-affected arm. Concentrated, repetitive training of the more-affected limb is usually performed for six hours a day for a two to three week period. Compliance of the patient for the rigorous restraint and training schedule, as well as the required intensity of therapy provided by therapists in a clinical setting, are important issues to consider.
Modified CIMT (mCIMT) is a less intense treatment that involves the same principles as CIMT (i.e. restraint of the less-affected upper extremity and practice of functional activities of the more-affected extremity), but with less intensity than traditional CIMT (i.e. less time). The common therapeutic factor in all CIMT techniques includes concentrated, repetitive tasks with the more-affected arm.
Functional benefits appear to be largely confined to those individuals with some active wrist and hand movement. Studies have explored the efficacy of this intervention for improving functional outcomes post-stroke.
A number of neuro-imaging and transcranial magnetic stimulation studies have shown that CIMT can produce a massive use-dependent cortical reorganization that increases the area of cortex involved in the innervation of movement of the more-affected limb (Taub et al., 1999). In terms of studies examining the effectiveness of this treatment intervention, high quality randomized controlled trials (RCTs) have reported a positive impact for patients with stroke. However, functional benefits appear to be largely confined to those individuals with some active wrist and hand movement.
Authors*: Annabel McDermott, OT; Anita Menon, MSc; Robert Teasell, MD; Nicol Korner-Bitensky, PhD OT.