Posts Tagged CIMT

[WEB SITE] Constraint Mitt – Constraint Induced Movement Therapy 

In order to ensure total focus on the affected arm and hand, you will wear a constraint mitt on your unaffected side for most of the CIMT programme. The constraint mitt is a lightweight glove that fits on your hand and wrist.

To gain the most benefit from constraint induced movement therapy you should wear the mitt for 90% of your waking hours. On the first day of your CIMT programme your therapist will go through your daily routine in detail with you to agree the specific activities when you are allowed to remove the mitt. These may include:

  • Personal care activities (eg toileting, bathing)
  • Dangerous activities (eg driving, tasks with sharp or hot objects)
  • Activities involving water (eg showering)

A detailed list of activities will be drawn up and you will sign a contract to agree to only remove the mitt for an activity on the list. This gives you strict guidance on wearing the mitt and helps you to obtain maximum benefit from the CIMT programme.

While wearing the mitt you will find day-to-day activities more difficult. We therefore strongly recommend you complete a CIMT programme with support from a partner, family member or carer. They will be able to assist in tasks and allow you to wear the mitt for longer, which will help with your progress. Your CIMT therapist will provide guidance to your supporter on how they can help you while also promoting use of your affected side.

It is common to feel frustration while wearing the mitt. Constraint induced movement therapy is an intensive and challenging process. However, if you persevere with a CIMT programme you will make some significant improvements over a short period of time.

On completion of the programme you may take the constraint mitt with you – either to continue practice or as a memento of your hard work!

Source: Constraint Mitt | Our programmes for adults | Adults | CIMT | Constraint Induced Movement Therapy| Treatment for hemiplegia in Manchester City Centre

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[Abstract] Early versus late-applied constraint-induced movement therapy: A multisite, randomized controlled trial with a 12-month follow-up

Abstract

Background and Purpose

A direct comparison between the effects of constraint-induced movement therapy (CIMT) applied early after stroke and that of CIMT applied in the chronic phase has not been conducted. This study aimed to compare the long-term effects of CIMT applied 6 months after stroke with the results of CIMT applied within 28 days post-stroke.

Methods

This study was a single-blinded, multicentre, randomized controlled trial with a crossover design. Forty-seven patients received CIMT either early (within 28 days) or 6 months after stroke. Both groups received standard rehabilitation and were tested at 5 time points. The primary outcome measure was Wolf Motor Function Test (WMFT); the secondary measures were Nine-Hole Peg Test (NHPT), the Fugl-Meyer Assessment (FMA) of the upper extremity, Stroke Impact Scale, and Modified Rankin Scale (MRS).

Results

Compared with baseline data, both groups showed significant improvements in the primary and secondary outcome measures after 12 months. No significant differences between the 2 treatment groups were found before and after the delayed intervention group received CIMT at 6 months and during the 12-month follow-up. Both groups recovered considerably and showed only minor impairment (median FMA score of 64) after 6 months. The early intervention group showed an initially faster recovery curve of WMFT, NHPT, and MRS scores.

Discussion

In contrast to most CIMT studies, our study could not find an effect of CIMT applied 6 months after stroke. Our results indicate that commencing CIMT early is as good as delayed intervention in the long term, specifically in this group of patients who might have reached a ceiling effect during the first 6 months after stroke. Nevertheless, the early CIMT intervention group showed a faster recovery curve than the delayed intervention group, which can be a clinically important finding for patients in the acute phase.

Source: Early versus late-applied constraint-induced movement therapy: A multisite, randomized controlled trial with a 12-month follow-up – Stock – 2017 – Physiotherapy Research International – Wiley Online Library

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[Abstract] The Effect of Modified Constraint-Induced Movement Therapy on Spasticity and Motor Function of the Affected Arm in Patients with Chronic Stroke

Purpose: The purpose of this study was to explore the effect of modified constraint-induced movement therapy (CIMT) in a real-world clinical setting on spasticity and functional use of the affected arm and hand in patients with spastic chronic hemiplegia.

Method: A prospective consecutive quasi-experimental study design was used. Twenty patients with spastic hemiplegia (aged 22–67 years) were tested before and after 2-week modified CIMT in an outpatient rehabilitation clinic and at 6 months. The Modified Ashworth Scale (MAS), active range of motion (AROM), grip strength, Motor Activity Log (MAL), Sollerman hand function test, and Box and Block Test (BBT) were used as outcome measures.

Results: Reductions (p<0.05–0.001) in spasticity (MAS) were seen both after the 2-week training period and at 6-month follow-up. Improvements were also seen in AROM (median change of elbow extension 5°, dorsiflexion of hand 10°), grip strength (20 Newton), and functional use after the 2-week training period (MAL: 1 point; Sollerman test: 8 points; BBT: 4 blocks). The improvements persisted at 6-month follow-up, except for scores on the Sollerman hand function test, which improved further.

Conclusion: Our study suggests that modified CIMT in an outpatient clinic may reduce spasticity and increase functional use of the affected arm in spastic chronic hemiplegia, with improvements persisting at 6 months.

Source: The Effect of Modified Constraint-Induced Movement Therapy on Spasticity and Motor Function of the Affected Arm in Patients with Chronic Stroke | Physiotherapy Canada

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[Abstract] Constraint-Induced Movement Therapy for Chronic Hemiparesis: Neuroscience Evidence from Basic Laboratory Research and Quantitative Structural Brain MRI in Patients with Diverse Disabling Neurological Disorders (S43.003)

Abstract

Objective: This presentation will review the basic neuroscience research origins and the effects of Constraint-Induced Movement therapy (CIMT) on CNS structural neuroplasticity.

Background: Experimental hemiparesis in primates overcame chronic limb nonuse by applying specific behavioral neuroscience principles. This research led to formulating a model for the origination of sustained motor disability after neurological injury and its improvement by a novel therapeutic program. The therapy became adapted to treating children and adults and termed CIMT. Over the past 25 years multiple worldwide Randomized Controlled Trials of CIMT enrolled nearly 2000 patients with diverse neurological disorders (stroke, cerebral palsy [CP], multiple sclerosis [MS]), which indicated superiority of the approach against control therapies, with large treatment Effect Sizes and sustained retention of improved spontaneous real-world use of the hemiparetic limb. Ongoing research will describe basic and clinical neuroimaging methods to explore the basis for the clinical efficacy of CIMT.

Design/Methods: (1) Basic neuroscience models of experimental limb nonuse in rodents that had undergone adapted CIMT, which were followed by histological studies. (2) Voxel-based morphometry (VBM) of grey matter and Tract-based spatial statistics (TBSS) of white matter on structural brain MRI, which evaluated neuroplastic changes after upper extremity CIMT.

Results: (1) CIMT in rodents resulted in increased CNS axonal growth, synaptogenesis, and neurogenesis compared to control interventions, parallel with improved paretic limb use. (2) VBM demonstrated profuse cortical and subcortical grey matter increase following CIMT for stroke, CP, and MS. TBSS indicated significantly improved white matter integrity in MS. Neither structural brain changes nor comparable improved paretic limb use followed control interventions.

Conclusions: CIMT is increasing worldwide practice to improve reduced real-world limb use in chronic hemiparesis in diverse neurological diseases and ages of patients. Structural CNS changes following CIMT may support improved and extended functional use of the paretic limb.

Source: Constraint-Induced Movement Therapy for Chronic Hemiparesis: Neuroscience Evidence from Basic Laboratory Research and Quantitative Structural Brain MRI in Patients with Diverse Disabling Neurological Disorders (S43.003)

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[VIDEO] FAQs about CIMT for adults –  Constraint Induced Movement Therapy

Source: FAQs | CIMT | Constraint Induced Movement Therapy

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[ARTICLE] Can Short-Term Constraint-Induced Movement Therapy Combined With Visual Biofeedback Training Improve Hemiplegic Upper Limb Function of Subacute Stroke Patients? – Full Text

Abstract

ObjectiveTo Investigate the synergic effects of short-term constraint-induced movement therapy (CIMT) and visual biofeedback training (VBT) in subacute stroke patients.

MethodsThirty-two subacute stroke patients were enrolled and randomly assigned to one of three groups: short-term CIMT with VBT, VBT only, and control groups. We applied CIMT for an hour daily during VBT instead of the ordinary restraint time, referred to as ‘short-term’ CIMT. Short-term CIMT with VBT group received simultaneous VBT with CIMT, whereas the VBT the only group received VBT without CIMT for an hour a day for 2 weeks. The control group received conventional occupational therapy (OT) alone. Patients underwent the Purdue Pegboard Test, the JAMAR grip strength test, the Wolf Motor Function Test, the Fugl-Meyer Assessment (upper extremity), Motricity index and the Korean version of Modified Barthel Index test to evaluate motor functions of the hemiplegic upper limb at baseline, post-treatment, and 2 weeks after treatment.

ResultsNo significant differences were observed between short-term CIMT with VBT and VBT only groups. Both groups showed significantly higher scores compared to the control group in the WMFT and FMA tests. However, the short-term CIMT with VBT group showed significant improvement (p<0.05) compared with the control group in both grasp and pad pinch at post-treatment and 2 weeks after treatment while the VBT only group did not.

ConclusionShort-term CIMT with VBT group did not show significant improvement of hemiplegic upper limb function of subacute stroke patients, compared to VBT only group. Larger sample sizes and different restraint times would be needed to clarify the effect.

INTRODUCTION

Most stroke survivors have upper limb motor impairments, along with difficulties in performing activities of daily living [1]. Currently, there are several known intervention treatments for functional recovery of the upper limb after stroke.

Constraint-induced movement therapy (CIMT) has been shown to enhance hemiplegic upper limb functions at both early and late stages of post-stroke [2]. The test was developed by Taub et al. [3] to improve the function of the affected upper limb by limiting the motion of the intact upper limb and induce affected upper limb movement [4, 5]. The original CIMT program consisted of 2 weeks of restraining the unaffected upper limb for 90% of waking hours combined with forced use of the affected upper limb for approximately 6 hours per day during task-oriented activities. However, Page et al. [6] reported that 68% of 208 stroke patients said that they were disinterested in participating in CIMT. One domestic research study showed that 12 out of 46 patients dropped out when they participated in CIMT lasting for 14 hours daily for 2 weeks. The most common reason for dropping out in this study was the lack of participation in training time [7]. Therefore, in a clinical setting, various modified CIMT methods have been developed to improve participation rates.

Recently visual biofeedback training (VBT) has been studied and introduced as a therapeutic option because VBT might improve motor performance by effectively tuning the control structure [8]. Also, Kim et al. [9] reported a significant effect of spatial target reaching training based on visual biofeedback of the upper limb function in hemiplegic subjects. In their previous article, VBT group showed more significant improvement than the control group in the Wolf Motor Function Test (WMFT) and the Fugl-Meyer Assessment (FMA).

Several other studies have also been developed that recognize the effect of CIMT combined with other treatments [10, 11, 12]. In these trials, unaffected upper limbs were restrained for several hours daily, even when participants were not taking other combined therapies. However, it is not easy to apply restraint for more than 5 to 6 hours daily in a clinical setting and longer restraint times can compromise a patient’s therapeutic compliance. To overcome these limitations, it is necessary to find out whether there is any modified therapies have any effects such as a reduced restraint time in CIMT during combined therapy.

In this study, we applied a new CIMT protocol in a clinical setting, while maintaining the existing concept of CIMT. Both CIMT and VBT were performed simultaneously for 1 hour daily for 2 weeks. CMT is hereafter referred to as ‘short-term’ CIMT. We examined the effects of short-term CIMT combined with VBT on gross and fine motor functions and daily functions in patients with subacute hemiplegic strokes. We hypothesized that study participant who received short-term CIMT with VBT would demonstrate more improved outcomes than patients who received VBT alone.

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Fig. 3. The patient with right hemiparesis received ‘behavior simulation.’ The patient held a disc grip by finger flexors. (A) The patient tried to put the spoon in the bowl by forearm pronation. (B) On the other hand, the patient was required to supinate his forearm for getting the spoon to the mouth. There were three patients with left hemiparesis. (C) One received short-term CIMT and VBT simultaneously. (D) Another patient received only VBT. (E) Both patients participated in the catch balls’ game. The other patient received conventional occupational therapy. CIMT, constraint-induced movement therapy; VBT, visual biofeedback training.

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[VIDEO] Lydia’s Story – Constraint Induced Movement Therapy (CIMT) – YouTube

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[WEB SITE] CIMT – Constraint Induced Movement Therapy – Adults

Young adult tackles a dexterity challenge

What is CIMT?

Constraint Induced Movement Therapy (“CIMT” or “CI Therapy”) is a form of rehabilitation of the arm and hand following a neurological event such as a stroke.

Constraint induced movement therapy is suitable for adults with hemiplegia, where one arm is weaker than the other. CIMT involves rehabilitation of the weaker arm while restraining the stronger arm. CIMT can make significant and lasting improvements to the amount and quality of use of the affected arm, which can have a major impact on your quality of life and function.

Constraint induced movement therapy has a large body of scientific research behind it and the effects of the treatment have been shown not only on the hand and arm, but on the brain itself.

A constraint induced movement therapy programme is short but intensive. Treatment is provided daily over a period of 2 to 3 weeks and led by a specialist physiotherapist or occupational therapist. You will wear a restraint “mitt” on your stronger hand for 90% of your waking hours throughout the programme, and take part in intensive therapy sessions as well as home practice.

Explore our website for more information, or contact us to speak directly with one of our CIMT therapists.

 

more —> Adults | CIMT | Constraint Induced Movement Therapy

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[Abstract] Constraining movement reveals motor capability in chronic stroke: An initial study

Abstract

Objective: To determine if persons with chronic stroke and decreased hip and knee flexion during swing can walk with improved swing-phase kinematics when the task demands constrained gait to the sagittal plane.

Design: A one-day, within-subject design comparing gait kinematics under two conditions: Unconstrained treadmill walking and a constrained condition in which the treadmill walking space is reduced to limit limb advancement to occur in the sagittal plane.

Setting: Outpatient physical therapy clinic.

Subjects: Eight individuals (mean age, 64.1 ±9.3, 2 F) with mild-moderate paresis were enrolled.

Main measures: Spatiotemporal gait characteristics and swing-phase hip and knee range of motion during unconstrained and constrained treadmill walking were compared using paired t-test and Cohen’s d (d) to determine effect size.

Results: There was a significant, moderate-to-large effect of the constraint on hip flexion (p < 0.001, d = –1.1) during initial swing, and hip (p < 0.05, d = –0.8) and knee (p < 0.001, d = –1.1) flexion during midswing. There was a moderate effect of constraint on terminal swing knee flexion (p = 0.238, d = –0.6). Immediate and significant changes in step width (p < 0.05, d = 0.9) and paretic step length (p < 0.05, d = –0.5) were noted in the constrained condition compared with unconstrained.

Conclusion: Constraining the treadmill walking path altered the gait patterns among the study’s participants. The immediate change during constrained walking suggests that patients with chronic stroke may have underlying movement capability that they do not preferentially utilize.

Source: Constraining movement reveals motor capability in chronic stroke: An initial study

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[WEB SITE] What is CIMT – Constraint Induced Movement Therapy

What is CIMT?

Constraint Induced Movement Therapy (“CIMT” or “CI Therapy”) is a form of rehabilitation of the arm and hand following a neurological event such as a stroke.

Constraint induced movement therapy is suitable for adults with hemiplegia, where one arm is weaker than the other. CIMT involves rehabilitation of the weaker arm while restraining the stronger arm. CIMT can make significant and lasting improvements to the amount and quality of use of the affected arm, which can have a major impact on your quality of life and function.

Constraint induced movement therapy has a large body of scientific research behind it and the effects of the treatment have been shown not only on the hand and arm, but on the brain itself.

A constraint induced movement therapy programme is short but intensive. Treatment is provided daily over a period of 2 to 3 weeks and led by a specialist physiotherapist or occupational therapist. You will wear a restraint “mitt” on your stronger hand for 90% of your waking hours throughout the programme, and take part in intensive therapy sessions as well as home practice.

Explore our website for more information, or contact us to speak directly with one of our CIMT therapists.

Source: What is CIMT | CIMT | Constraint Induced Movement Therapy

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