Archive for category Constraint induced movement therapy CIMT

[Abstract] Rehabilitation of stroke patients with plegic hands: Randomized controlled trial of expanded Constraint-Induced Movement therapy

via Rehabilitation of stroke patients with plegic hands: Randomized controlled trial of expanded Constraint-Induced Movement therapy – IOS Press

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[Abstract] Protocol for a Randomized Controlled Trial of CI Therapy for Rehabilitation of Upper Extremity Motor Deficit

Constraint-induced movement therapy (CI therapy) has been shown to reduce disability for individuals with upper extremity (UE) hemiparesis following different neurologic injuries. This article describes the study design and methodological considerations of the Bringing Rehabilitation to American Veterans Everywhere (BRAVE) Project, a randomized controlled trial of CI therapy to improve the motor deficit of participants with chronic and subacute traumatic brain injury. Our CI therapy protocol comprises 4 major components:

  1.  intensive training of the more-affected UE for target of 3 hour/day for 10 consecutive weekdays,
  2.  a behavioral technique termed shaping during training,
  3.  a “transfer package,” 0.5 hour/day, of behavioral techniques to transfer therapeutic gains from the treatment setting to the life situation, and
  4. prolonged restraint of use of the UE not being trained.

The primary endpoint is posttreatment change on the Motor Activity Log, which assesses the use of the more-affected arm outside the laboratory in everyday life situations. Data from a number of secondary outcome measures are also being collected and can be categorized as physical, genomic, biologic, fitness, cognitive/behavioral, quality of life, and neuroimaging measures.

via Protocol for a Randomized Controlled Trial of CI Therapy for… : The Journal of Head Trauma Rehabilitation

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[Abstract + References] Project Star Catcher: A Novel Immersive Virtual Reality Experience for Upper Limb Rehabilitation

Abstract

Modern immersive virtual reality experiences have the unique potential to motivate patients undergoing physical therapy for performing intensive repetitive task-based treatment and can be utilized to collect real-time user data to track adherence and compliance rates. This article reports the design and evaluation of an immersive virtual reality game using the HTC Vive for upper limb rehabilitation, titled “Project Star Catcher” (PSC), aimed at users with hemiparesis. The game mechanics were adapted from modified Constraint Induced Therapy (mCIT), an established therapy method where users are asked to use the weaker arm by physically binding the stronger arm. Our adaptation changes the physical to psychological binding by providing various types of immersive stimulation to influence the use of the weaker arm. PSC was evaluated by users with combined developmental and physical impairments as well as stroke survivors. The results suggest that we were successful in providing a motivating experience for performing mCIT as well as a cost-effective solution for real-time data capture during therapy. We conclude the article with a set of considerations for immersive virtual reality therapy game design.

References

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Jerome Iruthayarajah, Amanda McIntyre, Andreea Cotoi, Steven Macaluso, and Robert Teasell. 2017. The use of virtual reality for balance among individuals with chronic stroke: A systematic review and meta-analysis. Top. Stroke Rehabil. 24, 1 (2017), 68–79.
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Eun-Kyu Ji and Sang-Heon Lee. 2016. Effects of virtual reality training with modified constraint-induced movement therapy on upper extremity function in acute stage stroke: A preliminary study. J. Phys. Ther. Sci. 28, 11 (2016), 3168–3172.
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Michelle R. Kandalaft, Nyaz Didehbani, Daniel C. Krawczyk, Tandra T. Allen, and Sandra B. Chapman. 2013. Virtual reality social cognition training for young adults with high-functioning autism. J. Autism Dev. Disord. 43, 1 (2013), 34–44.
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Danielle E. Levac, Stephanie M. N. Glegg, Heidi Sveistrup, Heather Colquhoun, Patricia Miller, Hillel Finestone, Vincent DePaul, Jocelyn E. Harris, and Diana Velikonja. 2016. Promoting therapists use of motor learning strategies within virtual reality-based stroke rehabilitation. PloS One 11, 12 (2016), e0168311.
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Roberto Lloréns, Enrique Noé, Carolina Colomer, and Mariano Alcañiz. 2015. Effectiveness, usability, and cost-benefit of a virtual reality–based telerehabilitation program for balance recovery after stroke: A randomized controlled trial. Arch. Phys. Med. Rehabil. 96, 3 (2015), 418–425.
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Keith R. Lohse, Courtney G. E. Hilderman, Katharine L. Cheung, Sandy Tatla, and H. F. Machiel Van der Loos. 2014. Virtual reality therapy for adults post-stroke: A systematic review and meta-analysis exploring virtual environments and commercial games in therapy. PloS One 9, 3 (2014), e93318.
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Peter S. Lum, Gitendra Uswatte, Edward Taub, Phillip Hardin, and Victor W. Mark. 2006. A telerehabilitation approach to delivery of constraint-induced movement therapy. J. Rehabil. Res. Dev. 43, 3 (2006), 391.
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Victor W. Mark and Edward Taub. 2004. Constraint-induced movement therapy for chronic stroke hemiparesis and other disabilities. Restor. Neurol. Neurosci. 22, 3–5 (2004), 317–336.
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Nexhmedin Morina, Hiske Ijntema, Katharina Meyerbröker, and Paul M. G. Emmelkamp. 2015. Can virtual reality exposure therapy gains be generalized to real-life? A meta-analysis of studies applying behavioral assessments. Behav. Res. Ther. 74 (2015), 18–24.
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Hossein Mousavi Hondori and Maryam Khademi. 2014. A review on technical and clinical impact of microsoft kinect on physical therapy and rehabilitation. J. Med. Eng. 2014 (2014).
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Maria V. Nararro-Haro, Hunter G. Hoffman, Azucena Garcia-Palacios, Mariana Sampaio, Wadee Alhalabi, Karyn Hall, and Marsha Linehan. 2016. The use of virtual reality to facilitate mindfulness skills training in dialectical behavioral therapy for borderline personality disorder: A case study. Front. Psychol. 7, Article 1573 (2016), 1–9.
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Stephen J. Page, Peter Levine, Sueann Sisto, Quin Bond, and Mark V. Johnston. 2002. Stroke patients’ and therapists’ opinions of constraint-induced movement therapy. Clin. Rehabil. 16, 1 (2002), 55–60.
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Marco Pasch, Nadia Berthouze, Betsy Dijk, and Anton Nijholt. 2008. Motivations, strategies, and movement patterns of video gamers playing Nintendo Wii boxing. In Proceedings of the Facial and Bodily Expressions for Control and Adaptation of Games Workshop.
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via Project Star Catcher

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[WEB SITE] Constraint Induced Movement Therapy

WHAT IS CIMT?

taub2Constraint-Induced Movement therapy (CIMT/ CIT) or CI therapy is a new therapeutic approach to rehabilitation of hand and arm movement after stroke, cerebral palsy, brachial plexus injury, multiple sclerosis (MS) and traumatic brain injury (TBI). CI therapy consists of a family of treatments that teach the brain to “rewire” itself following a neurological injury. CI therapy is based on research by Prof. Edward Taub and his collaborators at the University of Alabama at Birmingham, USA that showed that patients can learn to improve movement of the weaker part of their bodies.CIMT is a 2-3 week treatment program that includes restraint of the non-affected hand for most of the waking hours and intensive practice of the affected one for specific hours per day. Practice is focused on everyday activities that are important for the patient and takes place in the clinic and at home. The daily home-based program is tailor made to match each person’s

HOW CIMT WORKS

CIMT includes restraint of the non-affected hand and intensive, everyday practice to the affected arm and hand.

CIMT’s functional effects have been observed as early as on the 3rd-4th day of the program. Improvements have been recorded to last for years after termination of therapy; the reason for this is that CIMT eventually increases the spontaneous use of the affected hand. That is directly linked to research studies showing that CIMT is the only rehabilitation technique to markedly change the organization of activity in the brain and remodel brain structures.

EFFECTIVENESS

CIMT is the only rehabilitative technique that is evidence based to substantially improve arm and hand movement in both adults and children in a 2-3 week period. A large, supporting body of research studies is available, some of which are large sampled randomized controlled trials. The most important finding from research studies and clinical observations is that improvements last for months or years after termination of the CIMT program.

CONDITIONS CIMT IS SUITABLE FOR

CIMT is suitable for adults and children that face movement difficulties (mostly) with their one arm and hand. This might have been the result of a central or peripheral neurological damage.

Although CIMT has been primarily designed for hemiplegia (muscle weakness and movement difficulties of the one side of the body), it can also be effective in quadriplegia when the one side of the body is the one that causes the main dysfunction. In general, CIMT is suitable for any case that non-use of the one arm/ hand affects the person’s independency in everyday activities.

To determine whether CIMT might be suitable for you, our therapists will apply a thorough functional evaluation.

The usual conditions that we treat are the following:

Cerebral Palsy

Cerebral palsy (CP) is the result of damage to the premature brain, either during pregnancy, birth or early infant years. CP can lead to muscle weakness, incoordination of movements and affected muscle tone. CP can affect all four limbs (quadriplegia), lower limbs only (diplegia) or one side of the body (hemiplegia). CIMT is suitable for hemiplegic CP and specific quadriplegic cases.

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Cerebrovascular Accident (Stroke)

A stroke usually results in movement difficulties in one side of the body (hemiplegia). Early after the incident, movement of the affected hand is clumsy and inefficient leading to unconscious avoidance of this part of the body and use of the healthy hand throughout most everyday activities. This compensation leads to further functional decrements as the muscles lose more of their strength, being underused.

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Brachial plexus injury-BPI (Obstetrical Palsy)

The brachial plexus is responsible for sensory and movement innervation of the entire upper limb. Lesions of the brachial plexus can lead to severe functional impairment. Obstetrical Palsy is a special type of BPI that occurs during the birthing process and affects all or part of the infant’s arm and hand.

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Multiple Sclerosis (MS)

Multiple Sclerosis is a chronic, auto-immune condition which means that for some unidentified reason the body triggers an inflammatory response affecting the nerves in the brain and/ or spinal cord. This can affect a person’s movements as the brain is unable to effectively transmit the messages to the nerves supplying the muscles. Movements may be slower and uncoordinated leading to functional problems with one or both arms during everyday activities.

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Traumatic Brain Injury (TBI)

Traumatic brain injury may occur in the area of the brain responsible for controlling movements in the arm and hand, leading to hemiplegia. It is known that people who have arm and hand weakness are more likely to compensate during functional activities by using their stronger arm. The reason for this is that movement of the weaker arm and hand may be slower or demanding greater effort, thus causing frustration. This condition progressively results in “forgetting” use of the weaker hand and spontaneously using only the healthy hand to accomplish everyday activities. This compensation leads to further functional decrements as the muscles lose more of their strength, being underused.

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For more visit site —>  Constraint Induced Movement Therapy | Constraint Induced Movement Therapy

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[Abstract] Towards an Immersive Virtual Reality Game for Smarter Post-Stroke Rehabilitation

Abstract:

Traditional forms of physical therapy and rehabilitation are often based on therapist observation and judgment, coincidentally this process oftentimes can be inaccurate, expensive, and non-timely. Modern immersive Virtual Reality systems provide a unique opportunity to make the therapy process smarter. In this paper, we present an immersive virtual reality stroke rehabilitation game based on a widely accepted therapy method, Constraint-Induced Therapy, that was evaluated by nine post-stroke participants. We implement our game as a dynamically adapting system that can account for the user’s motor abilities while recording real-time motion capture and behavioral data. The game also can be used for tele-rehabilitation, effectively allowing therapists to connect with the participant remotely while also having access to +90Hz real-time biofeedback data. Our quantitative and qualitative results suggest that our system is useful in increasing affordability, accuracy, and accessibility of post-stroke motor treatment.

via Towards an Immersive Virtual Reality Game for Smarter Post-Stroke Rehabilitation – IEEE Conference Publication

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[Abstract] Neurophysiological effects of constraint-induced movement therapy and motor function: A systematic review

There is a claim that improvements in motor function in people with stroke following constraint-induced movement therapy (CIMT) is due to compensation but not actually neurorestoration. However, few studies have demonstrated improvements in neurophysiological outcomes such as increased motor map size and activation of primary cortex, or their positive correlations with motor function, following CIMT. The aim of this study was to carry out a systematic review of CIMT trials using neurophysiological outcomes, and a meta-analysis of the relationship between the neurophysiological outcomes and motor function.

The PubMed, PEDro and CENTRAL databases, as well as the reference lists of the included studies, were searched. The included studies were randomised controlled trials comparing the effect of CIMT on neurophysiological outcomes compared with other rehabilitation techniques, conventional therapy, or another variant of CIMT. Methodological quality was assessed using the PEDro scale. The data extracted from the studies were sample size, eligibility criteria, dose of intervention and control, outcome measurements, and time since stroke.

A total of 10 articles (n=219) fulfilled the study inclusion criteria, all of which were used for narrative synthesis, and four studies were used in the meta-analysis. The methodological quality of the studies ranged from low to high. Strong, positive, and significant correlations were found between the neurophysiological and motor function outcomes in fixed effects (z=3.268, p=0.001; r=0.52, 95% confidence interval (CI) 0.227–0.994) and random-effects (z=2.106, p=0.035; r=0.54, 95% CI 0.0424–0.827) models.

Randomised controlled trials evaluating the effects of CIMT on neurophysiological outcomes are few in number. Additionally, these studies used diverse outcomes, which makes it difficult to draw any meaningful conclusion. However, there is a strong positive correlation between neurophysiological and motor function outcomes in these studies.

 

via Neurophysiological effects of constraint-induced movement therapy and motor function: A systematic review | International Journal of Therapy and Rehabilitation | Vol 25, No 4

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[Abstract] Rehabilitation Interventions for Upper Limb Function in the First Four Weeks Following Stroke: A Systematic Review and Meta-Analysis of the Evidence

Abstract

Objective

To investigate the therapeutic interventions reported in the research literature and synthesize their effectiveness in improving upper limb (UL) function in the first 4 weeks poststroke.

Data Sources

Electronic databases and trial registries were searched from inception until June 2016, in addition to searching systematic reviews by hand.

Study Selection

Randomized controlled trials (RCTs), controlled trials, and interventional studies with pre/posttest design were included for adults within 4 weeks of any type of stroke with UL impairment. Participants all received an intervention of any physiotherapeutic or occupational therapeutic technique designed to address impairment or activity of the affected UL, which could be compared with usual care, sham, or another technique.

Data Extraction

Two reviewers independently assessed eligibility of full texts, and methodological quality of included studies was assessed using the Cochrane Risk of Bias Tool.

Data Synthesis

A total of 104 trials (83 RCTs, 21 nonrandomized studies) were included (N=5225 participants). Meta-analyses of RCTs only (20 comparisons) and narrative syntheses were completed. Key findings included significant positive effects for modified constraint-induced movement therapy (mCIMT) (standardized mean difference [SMD]=1.09; 95% confidence interval [CI], .21–1.97) and task-specific training (SMD=.37; 95% CI, .05–.68). Evidence was found to support supplementary use of biofeedback and electrical stimulation. Use of Bobath therapy was not supported.

Conclusions

Use of mCIMT and task-specific training was supported, as was supplementary use of biofeedback and electrical simulation, within the acute phase poststroke. Further high-quality studies into the initial 4 weeks poststroke are needed to determine therapies for targeted functional UL outcomes.

 

via Rehabilitation Interventions for Upper Limb Function in the First Four Weeks Following Stroke: A Systematic Review and Meta-Analysis of the Evidence – Archives of Physical Medicine and Rehabilitation

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[Abstract] Efficacy of upper limb constraint-induced movement therapy in patients with stroke and impact on community activities: Outcomes of a pilot phase study

Abstract

Introduction

Constraint-Induced Movement Therapy (CIMT) is one of the techniques used to promote sensory-motor recovery of the upper limb in patients with stroke. The aim of this study was to design a pilot phase randomized controlled clinical trial to assess the efficacy of CIMT in the motor performance, and the incorporation of the affected upper limb in community tasks in stroke patients with less than 3 months of evolution.

Materials and methods

The sample was randomly assigned to either CIMT (n = 7) or a control group (n = 6). The outcome measures were assessed pre- and post-intervention by using the Fugl-Meyer Motor Assessment (FMA); dynamometry; Functional Independence Measure (FIM); Arm Motor Ability Test (AMAT); Motor Activity Log (MAL); and Community Activities Scale (CAS).

Results

Both groups were similar on demographics, clinical and baseline outcome scales. Significant effects were noted post-intervention in the CIMT group on AMAT (P<.05), MAL (p<.05), and CAS (P=.05). There were no differences on FMA (P=.880), dynamometry (P=.356), and FIM (P=.508) scores. CAS scale was correlated with tests for assessing the functionality of the upper limb. The relationship was high with the FMA scale (rho=.673) and time (rho = –.627), functional ability (rho=.784) and quality of movement (rho = 735) subscales of AMAT.

Conclusions

CIMT is effective to improve the integration and quality of movement of the affected upper limb in daily life activities and community tasks in individuals with stroke.

 

via Eficacia de la terapia de movimiento inducido por restricción para miembros superiores en pacientes con accidente cerebrovascular y su impacto en actividades de la comunidad: resultados de la fase piloto – ScienceDirect

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[Abstract] Effects of constraint-induced movement therapy for lower limbs on measurements of functional mobility and postural balance in subjects with stroke: a randomized controlled trial

Background: Constraint-induced movement therapy (CIMT) is suggested to reduce functional asymmetry between the upper limbs after stroke. However, there are few studies about CIMT for lower limbs.

Objective: To examine the effects of CIMT for lower limbs on functional mobility and postural balance in subjects with stroke.

Methods: A 40-day follow-up, single-blind randomized controlled trial was performed with 38 subacute stroke patients (mean of 4.5 months post-stroke). Participants were randomized into: treadmill training with load to restraint the non-paretic ankle (experimental group) or treadmill training without load (control group). Both groups performing daily training for two consecutive weeks (nine sessions) and performed home-based exercises during this period. As outcome measures, postural balance (Berg Balance Scale – BBS) and functional mobility (Timed Up and Go test – TUG and kinematic parameters of turning – Qualisys System of movement analysis) were obtained at baseline, mid-training, post-training and follow-up.

Results: Repeated-measures ANOVA showed improvements after training in postural balance (BBS: F = 39.39, P < .001) and functional mobility, showed by TUG (F = 18.33, P < .001) and by kinematic turning parameters (turn speed: F = 35.13, P < .001; stride length: F = 29.71, P < .001; stride time: F = 13.42, P < .001). All these improvements were observed in both groups and maintained in follow-up.

Conclusions: These results suggest that two weeks of treadmill gait training associated to home-based exercises can be effective to improve postural balance and functional mobility in subacute stroke patients. However, the load addition was not a differential factor in intervention.

 

via Effects of constraint-induced movement therapy for lower limbs on measurements of functional mobility and postural balance in subjects with stroke: a randomized controlled trial: Topics in Stroke Rehabilitation: Vol 24, No 8

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[BLOG POST] Constraint-Induced Movement Therapy After Stroke – Saebo

Constraint-Induced Movement Therapy After Stroke-blog

 

When a stroke causes a person to lose the use of one of their limbs, they can easily get frustrated, stop trying to use it at all, and start relying solely on the unaffected limb. This is called learned non-use; it means that the stroke survivor has learned to stop using an affected limb because of its lack of response.

Learned non-use makes it even more difficult for the patient to recover movement and function. This is why many physical therapists and occupational therapists use a technique called constraint-induced movement therapy (or CIMT) to help their patients recover as much movement and function as possible in affected limbs.

 

What is Constraint-Induced Movement Therapy (CIMT)?

constraint-movement-therapy-glove

CIMT is practiced most widely with hands and fingers. It consists of placing a mitt over the patient’s functional hand and forcing them to use the stroke-affected limb for several hours a day. The patient performs a repetitive movement so that the brain can repair the pathways.

This therapy technique uses two parts and is done for two weeks. The first part is to restrain the non-affected limb for 90 percent of the patient’s waking time. The second part is to get the patient to practice a specific movement for six hours a day, using shaping. Shaping, also known as adaptive task practice or ATP, is a method of training that involves breaking down tasks into manageable components and changing one parameter of the task at a time. Shaping improves motor relearning and problem-solving. This intensive program is meant to support the brain in making new pathways for movement in the affected limb.

CIMT is useful for both patients with chronic hemiparesis and those recovering from acute stroke. It helps patients of the chronic hemiparesis group overcome learned non-use. For patients recovering from acute stroke, CIMT contributes to preventing learned non-use in the first place. In both cases, CIMT is an effective tool in neurorehabilitation.

There is a somewhat less-intense version of CIMT, called modified CIMT (or mCIMT). It involves the exact same activities, i.e. restraint of the unaffected limb and practice of repetitive movements in the affected limb, but without the 90 percent of waking time and six-hours-per-day schedule of regular CIMT. However, the therapeutic factors remain the same: restraint of the unaffected limb and movement practice in the affected limb are what help with learned non-use and movement recovery.

 

How CIMT Works

brain-working

Several neuroimaging and transcranial magnetic stimulation studies have shown that CIMT can stimulate the brain into quickly reorganizing itself, especially in the areas of the cortex that control the affected limb. In other words, CIMT changes the brain so the patient can recover use of the affected limb.

Randomized controlled trials of CIMT have shown that in patients with some active wrist and hand movement, constraint-induced movement therapy had a positive impact on movement and function.

Specifically, the EXCITE trial, held between 2001 and 2003 at several universities, showed that CIMT helped patients with mild to moderate limb impairment learn to increase their use of the affected limb, effectively fighting learned non-use. The positive results lasted for as long as two years.

 

Saebo and CIMT

glory-saebo-glove

Several Saebo items can help with CIMT. The first is the SaeboGlove used for patients with difficulty opening the hands, weak hands and/or mild spasticity. For patients that have more than mild spasticity, the SaeboFlex is indicated. If the patient needs assistance with opening and closing fingers during CIMT therapy, both devices provide support via a spring or tensioner system which imitates the releasing motion once a person tries to let go of an object.

The SaeboMAS and SaeboMAS mini can also be used for CIMT. In the MAS the patient’s arm is unweighted, reducing tone in the hand allowing for more distal control. When the shoulder exerts itself, tone in the hand increases due to more effort taking place by the patient.

If the patient’s fingers are generally clenched into a fist but can be stretched open passively, using the SaeboStretch glove prior to CIMT will help the patient recover some range of motion. Depending on the severity of the case, many clients can reduce the tightness in the hand usually within several weeks to several months.

A Saebo-trained physical or occupational therapist uses Saebo therapy in conjunction with CIMT to promote stroke recovery, effectively fighting learned non-use and supporting neurorehabilitation.

Patients with mild to moderate impairment can benefit a lot from Saebo therapy and CIMT. The Saebo orthoses support the patient in gaining strength and range of motion, while CIMT fights learned non-use and promotes changes in the brain that lead to movement and function recovery in affected limbs.


All content provided on this blog is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. If you think you may have a medical emergency, call your doctor or 911 immediately. Reliance on any information provided by the Saebo website is solely at your own risk.

via Constraint-Induced Movement Therapy After Stroke | Saebo

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