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