Is Constraint-Induced Movement Therapy Really Effective for Patients After Stroke?

As a student pursuing a career in Physical Therapy, new therapies have always been like a candy to a child for me. The biggest goal of a physical therapist is to make their patients move freely and return to their activities in a better physical condition -Who doesn’t want to move better and be pain free?!  With the intent to help their patients, PT’s and other clinicians research on conditions that affect patients and create new approaches to treat them. One of the conditions that has the largest physical impairments on patient is stroke. 

Stroke is one of the leading causes of death and function impairment in the United States.  Stroke survivors usually experience some functional loss in their impaired limb. When a patient loses the function in one of their limbs, they usually feel frustrated and tend to rely on the unaffected one; this is called learned non-use. Learned non-use makes it even more difficult for the patient to recover as they’re not using their affected arm, use it or lose it - That’s why they say! 

This is why many physical therapists and occupational therapists use a technique called constraint-induced movement therapy (CIMT) to help their patients recover as much movement and function as possible in the affected limb.

What is CIMT?

Constraint-Induced Movement Therapy is a therapy that consists of the restricting of the unaffected limb while performing a variety of tasks with the affected one to overcome the learned non-use. Basically, the patient performs normal activities such as bathing, eating, dressing etc., with the affected hand and wear a mitt or glove on the unaffected arm 90% of waking hours. 

What are the advantages of CIMT?

Research shows that Constraint-Induced Movement Therapy increases the motor and functional recovery of the affective limb on stroke patients sooner compared to other therapies. CIMT is also equally effective at recovering motor and functional function of the affected limb at any stage post-stroke. These advantages are broken down into the following:

·       Overall greater improvement in function than conventional therapy.

·       Highly researched and highly credible treatment approach.

·       Increase social participation and patients ‘self-aware of their progress.

·       Decrease in medical cost over lifetime.

·       CIMT can be performed as a home program which may be feasible, effective and requires less therapist supervision. 

Components of CIMT

·       Restraint of the less affected arm.

·       Intensive therapy of the more affected arm 3-6 hours/ day. 

·       Monitoring arm use in life situations and problem solving to overcome perceived barriers to using the extremity.

·       Behavioral agreementin which patients commit to the rehabilitation process.

·      Treatment diary in which patients are able to track their progress.

Restraints

The restraints commonly used for CIMT includes:    

·       Half Glove

·       Mitt

·       Triangular bandage

·       Splint

·       Sling combined with a resting hand splint

·       Sling

·      Plaster cast 

Requirements for participation in CIMT

In order for a patient to participate in CIMT interventions, researchers suggest that the selected patients should have some hand function and meet the following criteria:

·       10 degrees’ active wrist extension 

·       10 degrees’ active thumb abduction 

·      10 degrees’ active extension 

Also in order for a patient to be eligible to receive CIMT, it is suggested that the patient should have adequate balance and walking ability while restricting the unaffected arm.

Models of CIMT

The most common and used model of CIMT is Modified Constraint-Induced Therapy.

 Modified CIMT:This is a less demanding model for the patient and therapist. The program consists of 3 hours per day for 5 days/week, for a minimum of 4 successive weeks. In total, there will be 20 treatment sessions totaling to 60 hours. The patient is expected to use his/her affected limb at home during each week day. 

How to get the most out of CIMT?

Now that we know what Constraint-Induced Movement therapy is, the real question is, how can this therapy be used to benefit stroke patients? –Well, here’s a few ways in which CIMT can be used successfully:

·      CIMT can be used as a home based program where patients wear a glove in their unaffected arm, while doing their activities with the affected one.

·      Patients can use a home diary to track their progress day by day.

·      CIMT can be used as a game based program, making more fun for the patient.

·      CIMT can be combined with other therapies to improve patients’ recovery.

·       Repeat each task several times rather than the hours spent.

 Improving the quality of life of our stroke patients is a team effort between the clinician, the patient and their loved ones. CIMT is one of the many treatments that can be effectively applied to help stroke patients relearn the skills they lost after stroke and arrive to a better level of functioning.

Additional Resources:

How to Use Modified Constraint Induced Movement Therapy with Our Patients That Had a CVA

Constraint-Induced Movement Therapy (CIMT): Current Perspectives and Future Directions

Yatneiry Reynoso-Jimenez is an undergraduate student majoring in Movement Science with a concentration in Sports medicine at Westfield State University. She is a member of ACSM and MAHPERD, as well as a Student Ambassador at Westfield State University. Her current research is on the effectiveness of Constraint-Induced Movement Therapy on Stroke patients. Yatneiry can be reached at https://www.linkedin.com/in/yatneiry-reynoso-jimenez-9991b813a/

References: 

1. Abdullahi, A. (2017). Number of repetition versus hours of shaping practice during constraint-induced movement therapy in acute stroke: a randomized controlled trial protocol. European Journal of Physiotherapy, 19(3), 173–176. 
2. Ho-Suk, C., Won-Seob, S., Dae-Hyouk, B., Sung-Jin, C. (2017). Effects of Game-Based Constraint-Induced Movement Therapy on Balance in Patients with Stroke. American Journal of Physical Medicine & Rehabilitation, 96(3), 184.

3.     Mickevičienė, D., Butkutė, J., Skurvydas, A., Karanauskienė, D., Mickevičius, M. (2015). Effect of The Application of Constraint-induced Movement Therapy on The Recovery of Affected Hand Function After Stroke. Baltic Journal of Sport & Health Sciences, 2(97), 15-22.

4.     Medee, B., Bellaiche, S., Revol, P., Jacquin-Courtois, S., Arsenault, L, Guichard-Mayel, A., … Laute, J. (2010). Constraint therapy versus intensive training: Implications for motor control and brain plasticity after stroke. Neuropsychological Rehabilitation, 20(6), 854-868.