Constraint-induced movement therapy (CIMT) started with the idea that the more you stimulate a limb, the more it is prone to react and gain agility. The idea behind CIMT is to restrain the movement of the unaffected limb so that the person is forced to mobilize his affected limb more often.

First, studies were conducted on monkeys and they showed the phenomenon of “learned non-use”. First the animal stops using the affected limb right after injury and learns to get along with the 3 remaining limbs. As time goes on, even after the affected limb heals, the monkey typically under-use the healed limb as it has gotten used to get along with the three remaining limb – this phenomenon was described as the “learned non-use” and it limits the recovery of the initially affected limb. By constraining the opposite limb, the animal is forced to use its healed or partially healed limb this reversed the “learned non-use effect”.

This forced use of the unaffected limb is known as constraint-induced movement therapy (CIMT).

A recent randomized controlled trial of CIMT was conducted on 227 patients who had a first stroke within the previous 3 to 9 months. Patients were assigned to either a 2-week program of CIMT (wearing a restraining mitt on the unaffected hand while engaging in repetitive task practice and behavioral shaping with the hemiplegic hand) or usual and customary care (this could range from no treatment to pharmacologic or physiotherapeutic interventions). The CIMT group demonstrated statistically significant improvements in all outcome measures that persisted for at least 1 year.

For patients to benefit from CIMT, it is often recommended that they have intact cognition and also meet the minimum motor criteria of being able to extend the impaired wrist and fingers to 20 and 10 degrees respectively. As for today, CIMT is still at an initial phase of development and requires a strong personal commitment as it is a very constraining technique and often an unpleasant experience. Yet, if you are interested by CIMT, don’t hesitate to mention it and discuss it with your physician.

Sources
MediFocus Guide from Medifocus.com
www.annals.edu.sg