Constraint Induced Movement Therapy (CIMT)

Authors
Affiliations

Doctor of Physical Therapy

B.S. in Kinesiology

Doctor of Physical Therapy

B.A. in Neuroscience

Books to read
  • O’sullivan - Ch12 CIMT1

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. Shaping1
  2. Task practice1
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.1

Adherence-enhancing behavioral strategies

(i.e., transfer package)

  • Daily administration of the Motor Activity Log (MAL)1
  • Home diary1
  • Problem-solving to overcome apparent barriers to use of the more-affected UE in the real-world situation1
  • Behavioral contract1
  • Caregiver contract1
  • Written home skill assignment with check-off list to determine adherence1
  • Home practice1
  • Daily schedule1
  • Weekly phone calls for the first month after treatment to administer the MAL and problem-solve1

Constraining use of the more-affected UE

  • Mitt restraint1
  • Any method to continually remind the participant to use the more-affected UE1

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

For attribution, please cite this work as: