What is CIMT?
CIMT is a form of therapy aimed at increasing the function of an upper limb following stroke of neurological damage. It involves the restraining of the unaffected or “good arm” for periods during the day.
What does it involve?
Studies have varied on hours of restraint per day and length of therapy. Traditional 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 . However compliance with this protocol has been found to be very difficult for many patients. One form of modified constraint induced movement therapy that has been found to be effective in improving functional reach and grasp, 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).
Who can do CIMT?
In order to participate effectively in a CIMT programme you will need to have 10degrees active extension at the joints in the fingers and 20 degrees active extension at the wrist. If spasticity is present your arm should be able to be moved through available range of movement with minimal difficulty. If pain is present it should not interfere with movement (less than 4/10 on a pain scale).
The main skills needed to successfully participate in CIMT are patience and determination. Not being able to use your stronger arm is frustrating and to keep doing it for 10-15 days can require a lot of determination.
People with balance problems should be cautious attempting CIMT as their “good arm” is restrained and not available to save them in a fall. Cognitive or language impairments may also make understanding and therefore compliance with the programme difficult.
What if I don’t have that amount of movement?
There are other options for upper limb training for arms with minimal activity.
Electrical stimulation – A current is applied to the target muscles to stimulate a muscle contraction ie wrist and finger extensors to open the hand. In order to gain any functional change the client must work with the stimulation doing tasks such as picking up and releasing a ball, and ideally in an intensive programme.
Saebo ‘s Functional Dynamic Orthotic- This is a piece of equipment which is worn on the affected hand for 2 x 45min sessions a day. The orthosis assists in opening the hand allowing the wearer to participate in an active, intensive programme of upper limb tasks.
Physiotherapists at Advanced Rehab Center can assess and advise you on the best treatment options for you.