Posts Tagged Constraint therapy
Problem. PTs often make stroke survivors make 8 trips around the gym each day while OTs may treat the upper extremity for only 4 to 11 minutes out of a 47 minute treatment session (1). It is not surprising that repeated practice in PT produces quick leg recovery after a stroke.
Problem. Constraint therapy forced doctors to accept that recovery is possible years after a stroke BUT it is only for stroke survivors who already have some hand movement and who agree to an intense schedule of 2 to 6 hours of supervised therapy per day.
Harris and associates designed a self-administered hand therapy program for a larger range of stroke survivors with a less intensive approach (2). One-hundred and three subjects with mild, moderate, and severe impairment on the upper extremity Fugl-Meyer test (UEFM) were recruited soon after they were admitted to a rehab hospital. Subjects in the experimental group were given booklets and equipment graded to their level and asked to do exercises and functional tasks for 1 hour a day 6 days a week during breaks in the therapy schedule. Subjects actually did an average of 3 hours spread over 4.8 days per week. Subjects in the control group read and did homework about stroke and their health during breaks in the therapy schedule. A site coordinator taught the program and then monitored each subject once a week.
Experimental subjects did an average of 12 hours of self-administered hand therapy spread over 4 weeks while in a rehab hospital. They were significantly better than control subjects at reaching for and grasping objects on the ARAT (P=0.031) and using their hand during functional tasks on the Chedoke (P<0.001). A limitation for self-administered therapy is cognitive and language deficits. Stroke survivors in this study were excluded if they had receptive aphasia or a score below 20 on the Mini Mental Status Examination (MMSE). A score of 18 to 23 on the MMSE indicates a mild cognitive impairment.
A self-administered hand therapy program that required minimal therapist time and moderate client time to supplement in-patient OT produced significant gains in hand recovery for stroke survivors with minimal cognitive impairments.
1. Berhardt J, Chan J, Nicola I, Collier J. Little therapy, little physical activity: rehabilitation within the first 14 days of organized stroke unit care. J Rehabil Med. 2007;39:43-48.
2. Harris JE, Eng JJ, Miller WC, Dawson AS. A self-administered graded repetitive arm supplementary program (GRASP) improves arm function during inpatient stroke rehabilitation. Stroke. 2009;40:2123-2128.
Information last checked: April 2013
What were we asked?
A parent wanted to know if there was any evidence that constraint induced movement therapy (CIMT) was effective at improving manual ability in children with hemiplegia.
What did we do?
In 2012 we searched a range of academic databases including NHS Evidence, the Cochrane Library, TRIP database, NICE guidelines and Pubmed for evidence and articles on this topic. This search was updated in April 2013.
What did we find?
What is CIMT?
CIMT is a therapy for children with hemiplegia which involves encouraging use of the affected arm while restricting use of the unaffected arm. The initial version of CIMT involved a strict regimen. Modified versions of CIMT vary in the therapy regimen, the frequency and duration, and type of constraint. In this summary, we use CIMT as an umbrella term to include modified versions of the therapy.
- Different types of constraint include gloves, mitts, casts, slings or splints. Mitts and gloves are commonly used as they restrict the unaffected arm whilst still allowing for the arm to be used in the event of a trip or fall.
- CIMT has been carried out at home, preschool, hospital or at a designated camps, and in some cases parents and carers have been trained to deliver the therapy.
- There are some concerns about whether constraint has a detrimental or harmful effect in the long term, and whether the ‘non-impaired’ arm is wholly unaffected.1
- The number of randomised controlled trials (RCTs) investigating this treatment has increased in recent years, which suggests a growing interest in the therapy.
What studies were found?
Continue —> Peninsula Cerebra Research Unit.