CIMT for Physiotherapy

CONSTRAINT INDUCED MOVEMENT THERAPY

CIMT (or CI therapy) is a type of treatment of clients with
motor system limitations that combines constraint or
immobilization of the unaffected arm with forced use of
the affected limb.
# INTRODUCTION
o A hand mitt or sling is used to constrain the
use of the unaffected upper limb while the
affected limb is engaged in a forced-use,
mass practice meaningful motor task.

CIMT and the learned nonuse theory are based on
deafferentation experiments in monkeys done by Dr. Edward
Taub.
# HISTORY
o Early primate studies demonstrated that if the
upper limb was surgically impaired by dorsal
rhizotomy to disrupt afferent input to the
sensory cortex.
o the animal stopped using the limb for
function.
o Active mobility was restored by immobilizing
the intact upper limb for several days while
training the animal to use the affected limb.

The first report of CIMT for hemiparesis in humans was by
Ostendorf and Wolf in 1981.
o CIMT has been shown to be an effective therapy in persons
with chronic stroke who have sufficient residual motor control
to benefit from the exercises.
o It is useful in brain-injured patients, in children with hemiplegic
cerebral palsy, and in patients with Parkinson disease.
o hemiparesis, incomplete spinal cord injury, and fractured hip.
o Other diverse chronic disabling conditions, including
nonmotor disorder such as phantom limb pain may also
benefit from CIMT

CIMT is based on the theory that impairment in hand and
arm function in clients after a stroke is compounded by
learned nonuse of that affected upper extremity,
which leads to a physical change in the cortical
representation of the upper limb in the primary sensory
cortex.
Learned Non-use
Result of an upper motor
neuron lesion that depresses
the central nervous system
and motor activity after a
stroke
Use of the uninvolved
extremity more often to
compensate for lack of
movement in the
involved extremity
Learn to NOT use the
involved extremity

o Learned nonuse develops in the early stages after a
stroke in humans as the patient compensates for difficulty
using the impaired limb by increasing reliance on the
intact limb.
o This compensation will hinder the recovery of function in
the impaired limb

CIMT works by encouraging re-organisation of the brain
so that a larger part becomes active when the person
uses their weaker arm.
The person also develops an improved awareness and
motivation to use their weaker arm thereby overcoming
the cycle of learned non-use.
Goals:
o Purposeful movements when performing functional
tasks.
o Improve the use of the affected limb
o Cortical Reorganization: teaches the brain to grow
new neural pathways

CIMT involves two main components:
1. Restraint of the unaffected arm using a mitt, sling or cast to
encourage use of the weaker arm
2. Repetitive practice of functional tasks with the weaker hand.
# COMPONENTS

These criteria includes:
o The ability to start from a resting position of forearm
pronation and wrist flexion
o Actively extend each metacarpal-phalangeal and
interphalangeal joint at least 10 degrees
o Extend the wrist at least 20 degrees through a ROM.
# CRITERIA FOR THE INCLUSION

# PROTOCOL/PROCEDURE
o Restraint of the unaffected arm with a mitt, sling, or glove for
90% of waking hours for a 2- to 3-week period
o therapeutic sessions with physical and occupational therapy in
which patients concentrate on intense, repetitive task training
of the more affected upper extremity for 8 hours a day.
(typically 6 to 7 hours)
o The clients must reinforce this training in home activities and
ADLs

o Activities may include picking up or stacking small objects
and functional everyday tasks
o The therapist’s role is to give tactile and verbal feedback
and instruction, along with assistance for the desired skill
training.
o Clients must keep a daily treatment diary to document the
amount and intensity of therapeutic intervention and the
amount of time spent wearing the mitt or sling each day for
the duration of the intervention

o Acquisition of new motor skills
o Increased use of the affected arm in functional activities
such as dressing, eating, tying shoe laces and brushing teeth
o Improved quality of movement
o Enhanced independence with everyday tasks
o Improved sense of well being
o Improved quality of life
# BENEFITS OF CIMT

o Typically for patients with higher level of function
o Time consuming and longer period of treatment
o Patient endures many hours of frustration which may affect
active participation of the patient
o Longer treatment = higher cost to patient
o Not reimbursable through insurance
o Acute CIMT can be harmful by increasing the size of the lesion
# DISADVANTAGES

1. Physical rehabilitation, Susan B O’Sullivan 6th edition
2. Neurological Rehabilitation, Darcy A Umphred 6th edition
3. Taub, E. et al. Constraint induced manual therapy and massed practice.
Stroke. 2000; 31:983-991.
4. https://www.rehabbasics.co.uk/constraint-induced-movement-therapy-
cimt/#:~:text=CIMT%20works%20by%20encouraging%20reorganisation,cycle
%20of%20learned%20non%2Duse.
5. https://www.physio.co.uk/treatments/paediatric-physiotherapy/constraint-
induced-movement-therapy-cimt.php
# REFERENCES

J.S Tedla et al, (2022) conducted a study on “Effectiveness of Constraint-
Induced Movement Therapy (CIMT) on Balance and Functional Mobility in the
Stroke Population: A Systematic Review and Meta-Analysis”
reviewed 161 studies from Google Scholar, EBSCO, PubMed, PEDro, Science
Direct, Scopus, and Web of Science and included eight randomized controlled
trials (RCT) in this study.
This results showed positive effects of CIMT on balance in three studies and
similar effects in five studies when compared to the control interventions such as
neuro developmental treatment, modified forced-use therapy and
conventional physical therapy.
a meta-analysis indicated a statistically significant effect size by a standardized
mean difference of 0.51 (P = 0.01), showing that the groups who received CIMT
had improved more than the control groups.
For more details
# RECENT STUDY

PRESENTED BY: DINU DIXON
MPT (NEUROLOGY)
HANKS

CIMT for Physiotherapy

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