Constraint Induced Movement Therapy (CIMT)

Authors
Affiliations

Nate Yomogida, B.S., SPT

Doctor of Physical Therapy

B.S. in Kinesiology

Chloë Kerstein, B.S., SPT

Doctor of Physical Therapy

B.A. in Neuroscience

Books to read
  • O’sullivan - Ch12 CIMT

CIMT is a method of forced-use designed to Promote Increased Use of an impaired UE. This intervention can be applied in the clinic and at home.

Mechanism

CIMT works through two main mechanisms:

  • Learned Nonuse
  • Use-Dependent Brain Plasticity

Results

Indications

Notes from class

Research supports use for Mild to Moderate UE Hemiparesis

Main elements

Class notes
  1. Intensive Training of the More-Impaired UE for Multiple days
  2. Training with a behavioral technique termed Shaping
  3. Applying a “Transfer Package” of adherenceenhancing behavioral methods designed to transfer gains made in the research laboratory or clinical setting to the patient’s real-world environment
  4. Inducing the patient to use the more-impaired UE during waking hours over the course of tx, usually by restraining the less-impaired UE

Task Oriented Training

Task oriented training includes:

  1. Shaping
  2. Task practice
Example

participant is executing a shaping task involving unscrewing a nut from a bolt (A) at a lower level of complexity, with the bolt placed closer to her, and (B) at a higher level of complexity, with the bolt placed farther away.

Adherence-enhancing behavioral strategies

(i.e., transfer package)

  • Daily administration of the Motor Activity Log (MAL)
  • Home diary
  • Problem-solving to overcome apparent barriers to use of the more-affected UE in the real-world situation
  • Behavioral contract
  • Caregiver contract
  • Written home skill assignment with check-off list to determine adherence
  • Home practice
  • Daily schedule
  • Weekly phone calls for the first month after treatment to administer the MAL and problem-solve

Constraining use of the more-affected UE

  • Mitt restraint
  • Any method to continually remind the participant to use the more-affected UE

CPG / Effectiveness

See Strokaengine’s recommendations

References

1.
O’Sullivan SB, Schmitz TJ, eds. Improving Functional Outcomes in Physical Rehabilitation. 2nd ed. F.A. Davis Company; 2016.

Citation

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