What Is Constraint Induced Movement Therapy And Why Should You Try it?

With Dr. Nick Housley and Dr. Steve Wolf 27th Jan, 21


Every year, about 16.9 million individuals in the globe experience their first stroke, with over 33 million stroke survivors and 5.9 million stroke-related deaths recorded, making stroke one of the leading causes of acquired adult disability. Around 80% of these survivors suffer upper-limb motor deficits that limit their ability to do everyday tasks and participate in social activities.

After a stroke, the degree of upper limb paresis is an independent predictor of fundamental daily tasks. Compensatory strategies (i.e., helping people perform tasks differently or using adaptive aids) were used to treat this disability because people believed that if a brain injury occurred, the issues that were lost could not be repaired and that remnants of those tissues could never be used again to regain movement. This was all until the 1970s, when a glimmer of hope appeared: nerve cells that could be triggered which were previously being utilized in a particular manner. Over the period of last 30 years the idea has turned into reality with the advent of term “NEUROPLASTICITY” (the ability of the brain and its neurons to reshape and re-function themselves in a purposeful way).

To address the question of how it’s done, all that was required was to try to optimize the use of an injured limb rather than just presuming it couldn’t be used and to educate people on how to compensate for what they couldn’t accomplish with their impaired limb using their better limb. Three treatment packages are included in the signature protocol for the original version of CIMT:

  • The intense, graded practice of the paretic upper limb for up to 6 hours a day for 2 weeks to improve task-specific use of the afflicted limb (i.e. shaping, in which patients are gradually trained for activities that progressively increase in difficulty).
  • Constraint or forced use therapy, in which the non-paretic upper limb is contained in a mitt to promote the use of the impaired limb for 90% of the total hours awake.
  • Adherence-enhancing behavioral methods designed to transfer the gains made in the clinical setting or laboratory to the real-world environment of patients (i.e. a transfer package). As a result, CIMT employs rehabilitation medicine’s operant training methods.
We now have ways to confirm that there are activation patterns of the brain, which we can see through imaging of the brain, through electrical stimulation outside the brain, or within the brain, of certain cortical areas, which strive these functions that we didn’t think existed or can rely on, using electrical stimulation and measurement techniques of the brain.

As a result, a lot of the task-specific neuro-rehab that we perform is guided by our understanding that these task-specific behaviors may rewire the brain. As a result, the amount of compensation we need is reduced, and the amount of activity we can do with our damaged or weaker arm is facilitated or driven.

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