Constraint Induced Movement Therapy (CIMT)

Question 1

in adults

Answer 1

One type of task-oriented training originally used with individuals post-stroke to:

• Increase functional use of the paretic upper-extremity through massed practice + shaping
• While restraining the lesser-involved upper-extremity

Question 2

forced use

Answer 2

Repetitive use of the affected limb during daily activities is “forced” because of the mitt on the less-affected hand

Question 3

constraint induced

Answer 3

Constraint = mitt/cast strong hand
– Shaping = operant training
– Use of the limb = reinforcement
– Targeted massed practice using weaker hand while wearing constraint

Question 4

applications of pediatric CIMT for children with CP include

Answer 4

A broad range of age groups (infancy through
adolescents)
• A range of abilities and co-morbidities
• Different contexts, including home, clinic, hospital, community
• Different dosages, intensities and durations

Question 5

developmental learned non-use: conditioned suppression of movement

Answer 5

• The child attempts to use the weaker side but finds it very challenging and many times is unsuccessful
• — The child stops using the weaker, affected side and chooses to use a unilateral approach with the stronger, non-affected side
• — The child finds some success using a “one-handed” approach and through “learned non-use” the child decreases attempts to use the weaker side
• — Non-use leads to contraction of the cortical representation in the brain of the affected side

Question 6

5 essential elements of P-CIMT

Answer 6

1. constraint of the less impaired UE
2. high dosage
3. use of shaping techniques and repetitive practice with task variation
4. sessions take place in the child’s natural environment
5. transition/discharge program

Question 7

P-CIMT constraint options

Answer 7

full arm cast
hand mitt
arm sling

Question 8

MR3 cycle chart

Answer 8

movement -> reinforcement -> repetition -> refinement ->

Question 9

selecting goals and targeted movements

Answer 9

Guided by assessment
• Consider participation deficits
■ Parent’s priorities
– Collaboration with families on goals
• Specific movements that are missing or impaired • Goals include:
• Sensory (awareness/discrimination)
• Bilateral UE skills
• Unilateral UE skills (affected arm)
• Gross motor skills
• Self care
• Play (ride tricycle, play in sand, push baby cart)

Question 10

motor learning theory and principles

Answer 10

Tasks selected to elicit repeated movement and motor patterns
• Child’s “just right challenge” (emerging skills)
• Repetition and elaboration of motor skills
• Frequent reinforcement
• Shaping

Question 11

shaping

Answer 11

• The therapist uses small steps, slowly increasing the difficulty of the task.
• As the child improves, the task are made more challenging
• Constraints are added to the task to elicit particular movements.

Example: Target is moved further away or higher requiring change in reaching pattern

Question 12

sensory motor activity examples

Answer 12

• Finding items in containers filled with dried media
• Crawling on carpet
• Exploring various textured materials,
• Messy play
• Water play

Question 13

strengthening activity examples

Answer 13

• Weight bearing on hands in crawling or transitions
• Handling small weighted play items
• Playing with materials that have resistive qualities
• Moving hand (e.g., drawing, painting) on a vertical surface

Question 14

transition program - discharge planning

Answer 14

Daily habits and routines can help the child incorporate new skills into everyday play and functional activities
– Consider how the child would use his/her non- dominant hand in tasks and daily occupations
– In most play activities, the child’s affected/weaker upper extremity will be primarily a “helping” arm or hand
– Consider typical uses for arms/hands
(home, school, sports, music/arts, play/games)

Question 15

camp based CIMT programs

Answer 15

Preschool age children
• 1 week day camp providing CIMT 6 hrs a day

Children 8-17 yrs (with and without botox injection prior)

Adolescents (13 to 18 yrs)
• 2 week day camp providing CIMT for 7 hrs a day

Question 16

MUSC CIMT programs

Answer 16

Preschool
• Day camp program
• 5 consecutive days, 6 hours per day
• Constraint with a resting hand splint and a puppet
• Ratio of 2 OT/PT students to 1 child
• Approximately 7-9 children at each camp

Question 17

criteria for participants for MUSC CIMT program

Answer 17

Inclusion
– Hemiparesis
– Ages 3 to 6 years of age
– Gross volitional use of affected
hand
– Willingness to use affected hand
– Agreeable to separating from parent
– Social skills

Exclusion
Severe mental handicap
Child requires nap in the afternoon
Behavioral issues that would prevent full participation in a social, preschool program

Question 18

intervention for CIMT for infant/toddlers

Answer 18

Developmentally appropriate activities
– Sensory exploration
– Pacifier to mouth
– Oral exploration
– Self feeding finger foods
– Weight-bearing
■ Routine based activities, not extra practice