What is Constraint Induced Therapy (CIMT)?
CIMT is a form of therapy aimed at increasing the function of an arm and hand following stroke or brain injury in addition to incomplete spinal cord injury, multiple sclerosis and cerebral palsy. It involves the restraining of the unaffected or “good arm” for periods during the day over a specific treatment period. During this time, carefully planned functional and therapy tasks are performed, designed to facilitate optimum re learning of the brain.
What does it involve?
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 combination with wearing a restrictive mitt or sling for 90% of waking hours. There has been some variance in protocols delivered at a lower intensity but spanning a 3 week period in recent research. This is thought to enhance compliance.
One form of modified CIMT 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. Therapists report that stroke victims disabled for many years have made some recovery in 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).
Close therapist supervision is paramount during the treatment period due to the emphasis on the quality of the movement. Good quality limb movements have greater therapeutic gains as they utilise limb muscles and structures efficiently.
Our therapists are able to set up treatment programs so the hours are achieved in the persons home as well as in clinic. Our therapists take a strong coaching role, teaching people to recognise quality movements. This positive feedback is incredibly important – it helps to maintain motivation and teaches the person to understand the importance of a task, how to do it well and therefore gain the best out of the practice when the therapist is not there.
Does it work?
Yes. This treatment approach is deemed ‘strongly recommended’ in the Clinical Guidelines for Stroke Management 2017. Outcomes can be excellent, however these are based on carefully selecting the right person for the treatment and designing the right program for them. There are certain criteria which predict a better functional outcome and a therapist will discuss these with you.
Who can do CIMT?
In order to participate effectively in a CIMT program, you will need to have 10-20 degrees active extension (straightening) at the joints in the fingers and wrist and addition to 10 degrees of abduction (outward movement) or extension of the thumb. If pain is present, it should not interfere with movement and be less than 4/10 on a pain scale. The therapist will also assess fatigue, cognition, walking safety and balance as these are all important considerations which can impact on the outcome or suitability of CIMT.
The main skills needed to successfully participate in CIMT are patience, motivation and determination. Not being allowed to use your stronger arm is frustrating and to keep doing it for days can require a lot of determination. A consistent support person is also key. Having someone by your side both practically and emotionally is vital for being able to complete the program. It’s certainly a marathon!
What if I don’t have that amount of movement?
There are other options for upper limb training for an arm and hand with less movement and therapy can still be very effective. The therapists at Advanced Rehab Centre conduct a very detailed assessment and based on this, they design the best treatment program for you.
In summary, CIMT is a well-researched and highly effective treatment approach for the right person with neurological upper limb dysfunction. The principals behind the protocol are practice intensity, task specific training and treatment progression which has been shown to optimally drive neuroplasticity and task re- learning after stroke. If you feel this treatment may help you, or a loved one, it’s important to be assessed by a neurological physiotherapist or occupational therapist with a special interest and experience in this field.
This program can be delivered in clinic, at home or by telehealth. NDIS participants may have access to funding as well as those with access to a private health fund, DVA, Home Care Package or Medicare Chronic Disease Management Plan. Contact our referrals co-ordinator on (02) 9906 7777 or firstname.lastname@example.org for further information.