CIMT Flashcards by Jawric Cuyzon

What is neuroplasticity?

Brain’s ability to reorganize and form new neural connections

Response to training and practice

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Motor skill learning is dependent on what to make changes in the motor cortex?

Enriched environment with intensive motor training

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What is the theory of learned non-use for early CVA?

Stroke pts try to use their affected limb

happens into the chronic stage to keep the training going

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What are the proposed mechanism of CIMT?

taking away learned non-use
by using dependent cortical reorganization

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Why does CIMT want to take away learned non-use?

constricting = use of the affected limb thru conditioning

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What is the premise of cortical reorganization?

repeated and sustained practice = increased cortical representation of the involved UE

practice = cortical representation

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What is the premise of learned non-use theory?

a low sudden hand use and poor functional ability is because:
- suppression of the ability thru sub-acute conditioning and learning compensation with the unaffected hand

= dimished cortical limb representation because of the theory (!!)

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What is the premise behind CIMT?

increased hand use and better functional ability through increased motivation and specific task practice

= changed cortical limb representation because of increased use

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What is the traditional programing for CIMT?

patients will participate in:
- 4-6 hrs
- 5x a week
- 2-3 weeks

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What is the programing for the UE for CIMT?

Wear a mitt on the uninvolved UE for 90% that they are awake for 2-3 weeks

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What is the programing for the LE for CIMT?

NO constraints but activities are focused on reliance on the involve LE

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What is the frequency of the modified program CIMT?

1-2 hours of PT and OT
3-5x a day over 3-4 weeks

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What is the programing for modified program CIMT?

focuses on CIMT activies
BUT
mitts only for 5-6 hours during waking hours

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What are the elements of CIMT?

intensive task-oriented training
behavioral strategies
restriction of the uninvolved extremity

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What are the components of task practice?

tasks are functionally relevant
global feedback
task is challenging but appropriate

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What is the purpose of global feedback for the patient?

PT gives feed given the overall performance

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Why is it important to have challenging tasks in regard pt improvement?

variety and difficulty is needed to regain movement control

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What is the frequency regarding functionally relevant tasks?

done continously for 15-30 minutes
- tasks like grooming, setting the table, etc.

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What is shaping?

reps of a specific movements in a series of trials
- also known as adapted task practice

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How is functional activities practiced in regards to shaping?

practiced for a set of 10 timed trials
- explicit feedback from PT in regard to performance in each trial

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What is the progression for functional activities in regard to shaping?

if they are too good :0 -
- either increase reps or decrease time

How are shaping tasks chosen?

based on movement goals
potential for improvements
patient preference

What is massed practice?

practicing a motor skill with little or no rest breaks between consant repetition of the skill

How is massed practice set up?

more work - less rest

Who is apart of the behavioral contract?

Contract between the patient/caregiver and therapist

What does the patient agree on for the behavioral contract?

wearing a mitt 90% of them being awake using the involved limbs as much as possible commitment to the HEP if there is a safety concern = take the mitt off

What does the caregiver agree on for the behavioral contract?

HEP accountability daily supervision regarding daily activities make sure no mitt during unsupervised times

What are the instructions given for functional tasks on a nightly basis?

to do with or without the mitt have constant supervision making sure to practice bilaterally

What is the purpose of the home diary?

Pt is asked to write in a diary daily while listing out: - activities being done with affected limb - when in the day was being performed - success or unsuccessful? - mitt compliance - any other comments

What is a motor activity log?

it is a subjective self-report of the amount and quality regarding the involved UE for 30 specific task - also an outcome measure

What is the goal of constraint of the uninvolved extremity?

avoid any future compensation but to **encourage** the use of the involved extremity

With non-dominant UE, how should functional activities be chosen?

with non-dominant UE then we want to make sure we are chosing them cautiously

What are the fine motor skills activity needed for non-dominant UE?

to help increase strength, ROM and coordination

What are the functional activities programed for non-dominant UE?

activities not expected of the non-dominant UE should be used carefully like writing may need to be bilateral activities i.e using non-dominant to stabilize the paper during writing or cutting food

What is the traditional UE movement criteria?

20 deg of wrist extension 10 deg extension of IP/MCP of each finger

What are the modified UE movement criteria?

all 10 deg of: - wrist extension - thumb abduction - IP/MCP extension of 2 fingers

What is the actual amount of use test (AAUT)

Video of a set of task scenarios while the patient is unaware they are being recorded Lookin at: - use of involved limb and the quality of the movement

Score - 0 for functional ability scale

doesnt even try with the affected arm

Score - 1 for functional ability scale

affected arm was moved during the task but not really helpful | very poor

Score - 2 for functional ability scale

affected arm has some use during a task but needed some help from the normal arm - very slow - difficult - needed more than 2 tries to finish | Poor

Score - 3 for functional ability scale

affected arm was used purposely but the movements were influenced by some synergy - movements were slow - only some effort | Fair

Score - 4 for functional ability scale

affected arm were almost normal - not as fast - not as accurate | Good

Score - 5 for functional ability scale

Affected arm is normal as it use to be - normal speed - normal accuracy

What is the wolf-motor function test?

**17 functional tasks** that test bilaterally - each movement is timed and assessed to look for movement quality

What are other considerations for CIMT?

balance issues aphasia cognitive status pain contractures sensation hearing/visual status Sit to stand medical stability TBI SCI peds MS PD Amputee LE surgery

Score - 0 Motor activity log

didn't even try to use the weaker arm | never

Score - 1 Motor activity log

occasionally used the weaker arm | very rarely

Score - 2 Motor activity log

sometimes used my affected arm - still used my stronger arm tho | rarely

Score - 3 Motor activity log

half the time, i used my weaker arm

Score - 4 Motor activity log

Used my weaker arm almost as much

Score - 5 Motor activity log

used it as much as before the stroke