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Constrained induced movement therapy
- 1. Constraint Induced Movement Therapy - Nidhi Chhabra
- 2. Objective
- 3. Introduction • CIMT involves constraining the unaffected limb, along with intense therapy, in order to force the use of the affected with the intent to improve motor function.
- 4. History • Early research was done by Edward Taub on surgically deafferented monkeys. • “learned non-use”.
- 5. • 3 components of CIMT – Restraint of unaffected arm. – Repetition, structured, intense practice of affected arm. – Monitored arm used in life situation and problem solving to overcome barriers.
- 6. Technique • Types of restraint included • Sling • Glove • Splint • Plaster • Total time of restraining – 90% of waking hours. • 6 hours/day of intense therapy on consecutive weekdays. • 2 to 3 week period.
- 7. • Minimum inclusion criteria – Upto 20 degree wrist extension – Upto 10 degree thumb abduction – Upto 10 degree finger extension.
- 8. Advantages Disadvantages Overall great improvements in function as compared to conventional treatment. Requires enormous labour. Highly researched treatment approach. Patient endures many hours of frustration. Increased social participation. Patient can suffer from muscle soreness resulting in stiffness and discomfort in the involved UE as well as skin lesions. Cortical reorganisation observed. Not beneficial for all stroke or head injury patients.
- 9. Evidence STUDY YEAR AUTHOR PATIENT RESULT RCT 2000 Dromeric A.W, Edwards D.F, Hahn M Acute stroke patients CIMT was associated with less arm impairment at the end of treatment. RCT 2002 Edward. T et al Children with Hemiparesis CP Major and sustained improvement in motor functions. RCT 2006 Wolf S. et al 3-9 months after stroke Clinically relevant improvement seen persisting for at least 1 year.
- 10. STUDY YEAR AUTHOR PATIENT RESULT RCT 1998 Wolfgang. H et al Chronic stroke patients, UE motor deficits Intervention had general applicability. RCT 2007 Boake et al Subacute stroke patients CIMT has little difference on overall outcome in motor movements. Meta-analysis 2010 Corbetta. D et al All RCTs and Quasi RCTs from Jan 2009 to April 2010 included Majority of studies were underpowered and imprecise, exposing the analysis to small-study bias. Large RCTs needed to resolve the uncertainties.
- 11. Modified CIMT • To promote better compliance. • Protocol : – 30 mins of 1 to 1 therapy for 3 days a week; – 5 hours/day in restraint (weekdays) for 10 weeks.
- 12. Modified CIMT • To promote better compliance. • Protocol: 30 mins of 1 to 1 therapy, 3 days/ week, 5 hours/day in restraint (weekdays) 10 weeks . Take home message
- 13. References • Constraint Induced Movement Therapy, Psych 428, May 2008. • Constraint Induced Movement Therapy: A New Family of Techniques with Broad Application to Physical Rehabilitation- A Clinical Review, Edward Taub et al. • www.ncbi.nlm.nih.gov/pubmed. • www.scholar.google.co.in.
- 14. Thank you !
Notes de l'éditeur
- More gain and improvement seem to be made using this technique, 3 months or more after stroke when compared to traditional therapy and also in children with hemiparesis Cerebral Palsy. Maybe its time to change PTs current treatment model for patients with learned non-use.