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Constraint Induced Movement Therapy 11120 Pediatrics-T 02-02-2021

Constraint Induced Movement Therapy (CIMT) is a rehabilitation technique aimed at improving motor function in children with hemiparesis by constraining the unaffected limb to encourage use of the affected limb. Developed from research on learned nonuse, CIMT involves intensive training of the affected extremity through repetitive tasks for several hours a day. Modified CIMT (MCIMT) addresses limitations of traditional CIMT by reducing therapy duration and employing a more child-friendly approach.

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3 views20 pages

Constraint Induced Movement Therapy 11120 Pediatrics-T 02-02-2021

Constraint Induced Movement Therapy (CIMT) is a rehabilitation technique aimed at improving motor function in children with hemiparesis by constraining the unaffected limb to encourage use of the affected limb. Developed from research on learned nonuse, CIMT involves intensive training of the affected extremity through repetitive tasks for several hours a day. Modified CIMT (MCIMT) addresses limitations of traditional CIMT by reducing therapy duration and employing a more child-friendly approach.

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Constraint Induced Movement

Therapy (CIMT)
What is CIMT?

 CIMT is a motor therapy program for children


with limited motor function in one of their
arm.
 It is a physical rehabilitation technique used
for children and adults with hemi paresis.
 It is an emerging therapy in the management
of upper extremity in hemi paretic cerebral
palsy.
CIMT

 Developedat the University of Alabama


Birmingham (Edward Taub, Director, CI
Therapy Research Group)

 Began with basic research done with


monkeys in which somatic sensation was
surgically abolished in one forelimb resulting
in somatosensory deafferentation.
CIMT


After somatosensory deafferentation, monkeys do not
use the forelimb in the free situation (problem is
nonuse).

 Hypothesis that the nonuse was a learning mechanism


termed
‘learned nonuse’.
Development of Learned Nonuse:
Hypothesis
Why there is developmental disregard
in hemi paretic Cerebral palsy?

 As a child with hemi paretic CP develops


they learn strategies and techniques to
manage their daily tasks and play with one
hand that is more efficient and effective &
learn not to use the affected limb for motor
function. This behavioral phenomenon is
called developmental disregard.
Rationale or assumptions in CIMT

 Neural plasticity or cortical reorganization.

 “Learnednon use” or developmental


disregard. (DeLuca).
Overcoming Learned Nonuse: Hypothesis
CIMT

 CIMT resolves the problem of learnt nonuse


by increasing the use of affected limb for
90% of waking hours by constraining the use
of less affected limb

 CIMT for hemiplegics includes forced use of


affected extremity.
CIMT

 It is one on one training program .

 Duration of therapy:

 6 hours per day for several weeks with


repetitive task practice and adaptive task
practice which is called shaping.
CIMT

 In this method the uninvolved extremity is


constrained using either a glove, forearm
splint, cast (short or long arm) or sling.
 The affected extremity is give an intensive
training with different functional tasks.
 Task involves overhead movement of
shoulder, elbow extension activities, forearm
supination, wrist extension, prehension and
precision activities.
Components of task training program

– CI training defines two types of training:

 Shaping or adaptive task practice (ATP)

 standard Task practice (TP)

 They are used with each participant as functional


activities (e.g., writing, turning pages) are repeated.
Shaping
 Derives its name from the behavioral training technique
developed by Skinner and others.
 A form of operant conditioning in which the probability of
experimenter determined behaviors are ‘elicited’ through
reinforcement (reward or punishment).
 The learner is relatively passive in this process while
performance is progressively ‘shaped’ as the behavioral
objective (task goal) is approached in small steps through
reinforcement or reward (positive feedback)
 Using this approach, a motor objective (task goal) is
approached in small steps by successive approximations (ie,
parts of the task), the task is made more difficult in accordance
with motor capability, or the speed of the performance is
progressively increased
Task specific practice
 Less structured than ‘shaping’ procedures.
 Tasks are not set up to be carried out as individual trials of
discrete movements
 They involve functionally based activities performed
continuously for a period of 15-20 minutes (e.g., setting the
table; wrapping a present).
 Progression: in successive periods of task practice, the spatial
requirements of the activity or other parameters (such as
duration) can be changed to require more demanding control of
limb segments for task completion.
 Feedback about overall performance is provided at the end of
the 15-20 minute period.
 Task Practice (functional tasks practiced as a
whole, e.g., wrapping a present; setting the
table)
 “Shaping” (adapted task practice)
Factors that are not clearly delineated
in CI therapy protocols

– Determining where to start is critical (thresholding


is essential for the right amount of challenge)

– Determining how to progress is essential and


takes a skilled clinician

– Choosing tasks is critical to motivation and patient


participation
CIMT Limitations:

 Extensive training
 Clinical resources for training
 Time consuming
 Tedious
 Financially more demanding, so changes of
adherence to therapy are less.
 Psychological stress to child
Modified CIMT

 Because of these limitations, the CIMT


approach for children was modified by
Stephen Phage and is called as Modified
CIMT.
 In MCIMT the duration of constraint of
uninvolved extremity and duration of task
practice for affected extremity is reduced
to 3hrs.
Modifications

 Child friendly approach


 Reduced hours of constraint and shaping
 Involves alternative method of constraint
i.e. either a sling , splint or glove and not
the conventional casting.
 Therapy is given in modified environment
i.e. at home in the form of play
Thank you

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