Constrain-Induce Movement

Therapy (CIMT or CI)

Constrain-Induce Movement

Therapy

Constrain-Induce movement

therapy is a treatment approach

that improves use of the more

affected extremity following a

Neurological injury.

CI therapy focus on the reuse of

the more affected side by

restraining the unaffected UE

limb.

CIMT Therapy Development

• CIMT therapy is based on research

by Edward Taub, Ph.D. and

collaborators at the University of

Alabama.

• The idea of CIMT therapy was

developed due to the initial

unsuccessful use of the affected

limb.

Dr. Taub calls this behavior

“Learned non-use”

• Dr. Taub began with basic research done with

moneys in which sensation was abolished in

one forelimb resulting in somatosensory

deafferentation.

• After elimination of sensory impulses monkeys

did not use the forelimb in the free situation

(problem is non-use).

• Hypothesis that the non-use was

a learning mechanism termed

“Learned non-use”.

CIMT Protocol

Motor Criteria UE : All movement criteria includes

• Ability to start from a resting position of forearm Pronation

and Wrist flexion.

• 10 degrees of active MCP and IP joint extension.

• 20 degrees of active wrist extension.

CIMT is focused on 4 major patient population

• CVA (Stroke)

• Cerebral Palsy (Pediatrics)

• TBI

• Multiple Sclerosis

CIMT Intervention

CIMT is a “therapeutic package” consisting of a

number of different components.

1. Practicing repetitive, task-oriented training of

the more impaired UE for several hours a

day for 10-15 consecutive weekdays.

Training Procedures

Shaping• Motor objective is approached

by small steps.

• Functional activity practiced for

a set of ten / 30s trials.

• Immediate feedback is

provided

Task Practice• Less structured task.

• Functional activity performed

continuously for 15-20 min.

• The tasks are not designed to

be carried out as identical and

rigid movements.

2. Restraint of the unaffected limb in a

protective safety mitt for 90% of waking

hours for a 2- to 3-week period in

conjunction with repetitive training of the

more affected UE

Transfer Package

Goals

• Transfer gains from clinical environment to real world

(home, community settings).

• Patient becomes responsible for his/her own

improvement.

• Patient is actively engaged in adherent to the

intervention without constant supervision.

• Attention to adherence is directed to using the MORE

impaired limb during functional tasks.

This component of the program is intended to

promote clients’ adherence.

Impact of CIMT in Physical

Therapy

• Post injury rehabilitation

training may focus on

promoting functional

recovery using the concept

of true recovery.

The question regarding which rehabilitation strategy is

most effective has been an ongoing debate in the

Physical Therapy field.

• Current CI therapy promotes

a newer substitutions

approach. The more affected

extremities may be used in a

new way, compared to before

the neurological injury, to

perform a functional task.

Further, due mainly to

reimbursement policies,

most intervention is

delivered in short treatment

periods, and in a distributed

manner, which represents a

substantial paradigm for

physical rehabilitation.

Functional Assessments

Motor Activity Log (MAL), is a structured interview that

collects information on how well and how often the more

affected UE was used in 30 important activities of daily

life.

Subcomponents

• Amount Scale (AS): How much they use their more

affected UE during the functional activities indicated.

• How Well Scale (HW): The quality of their movement.

Assessment Tools

Motor Activity Log

Amount of Use Scale

0 = Did not use my weaker arm (not used).

1 = Occasionally tried to use my weaker arm (very

rarely).

2 = Sometimes used my weaker arm but did most of the

activity with my stronger arm (rarely).

3 = Used my weaker arm about half as much as before

the stroke (1/2 pre-stroke).

4 = Used my weaker arm almost as much as before the

stroke (3/4 pre-stroke).

5 = Used my weaker arm as often as before the stroke

(same as pre-stroke).

Motor Activity Log

How Well Scale

0 = My weaker arm was not used at all for that activity (not used).

1 = My weaker arm was moved during that activity but was not helpful

(very poor).

2 = My weaker arm was of some use during that activity but needed

some help from the stronger arm, moved very slowly, or with difficulty

(poor).

3 = My weaker arm was used for that activity but the movements were

slow or were made only with some effort (fair).

4 = The movements made by my weaker arm for that activity were

almost normal but not quite as fast or accurate as normal (almost

normal).

5 = The ability to use my weaker arm for that activity was as good as

before the stroke (normal).

References

UAB School of Medicine

Taub Therapy Clinic

http://www.citherapy.net/

Improving Functional Outcomes

in Physical RehabilitationAuthor: O'Sullivan, Susan B

http://www.youtube.com/watch?v=0VYMMJVz3HI