Constraint Induced Therapy

Question 1

CIMT Overview

Answer 1

Pt.s use their weaker extremity by constraining the dominant one resulting in increased movement and functionality.
Teaches the brain to “rewire: itself following a stroke or brain injury and overcome the phenomenon of learned non use.
Clients recieve treatment 6 hours a day five says a week for 2-3 weeks (may not be the best for pt.s with comobidities)
It is the only rehab technique shown to produce a marked change in brain orginization and function. Pt. recover ~50% of their previous function.

Question 2

Plasticity

Answer 2

“use it or lose it”
CNS is not hardwired but rather responds to functional and enviornmantal demands
Change is ongoing : years post insult
Use - dependent plasticity
Brain allocates resources based on environmental needs.

Question 3

Practice

Answer 3

Should be repetitive (x100) and challenging
Synaptic transmission becomes stronger or weaker depending upon use
Individual cells can vary structure and function according to behavioral needs

Question 4

CMIT Basis : Shaping

Answer 4

operant conditioning wherby a behavioral objective is approached (movement) in small steps of progressively increasing difficulty

Question 5

CMIT Basis : Massed Practice

Answer 5

Several hours of therapy at a time

Question 6

CMIT : Protocol

Answer 6

At least 6 months post-onset in most cases
20 degrees of extension in the wrist
10 degrees of extension in each of the fingers
Ability to say at least 3 different word spontaneously (they must be able to understand directions and express their needs i.e. my hand hurts)
At least moderately intact receptive language
No more thant moderate verbal apraxia is ideal however clients w/ more severe apraxia are considered on a case by case basis

Question 7

Types of intervention

Answer 7

CIMT : Restraint of unnaffected UE with > 3 hours therapy/day (sling or hand splint in place for 90% of waking hours during usual ADL;s or dedicated exercises)
mCIMT (modifies) : Restraint of unaffected UE with 3 hours or < therapy/day
FU (forced use) Restraint of unaffected UE with no specific treatment of affected UE

Question 8

Gross Motor Tasks

Answer 8

Ball catching 
Twisting lids of jars 
Lift & place large objects in shopping bags 
Stack cans 
Open doors

Question 9

Fine Motor Tasks

Answer 9

Sort and stack change 
Pick up paper clips 
Manipulate buttons and zippers 
Play piano 
Board games 
Use can opener 
Use key to open door

Question 10

Functional Tasks

Answer 10

Cooking
Household Tasks (cleaning, folding clothes)
Maintenance tasks with tools
Vacuuming, mopping, sweeping