Lecture 19: Constraint Induced Movement Therapy-CIMT Flashcards
What is constraint induced movement therapy?
* Promote increased use of affected UE - because were constraining the other side
* Intense task-oriented practice of more affected UE for up to 6 hours a day- consecutive weekdays
* Less affected UE restrained from use up to 90% of waking hours
* Therapist uses shaping techniques to modify and progress performance
* Feedback, coaching, modeling, and encouragement provided during practice
* Behavioral methods designed to ensure adherence to exercise and developing task-oriented behaviors
Excite Study
Large prospective, single blind, randomized, multisite study that included 222 patients after stroke
Inclusion criteria - so extremely strict inclusion criteria for constraint induced - so it looked really good but this inclusion criteria was really tight and they may have just recovered on their own
* Potential for recovery
* Some residual upper arm and hand movement (already have some movement but tended not use this arm
* Limited pain
* limited spasticity
* Absence of cognitive impairment
CIMT in patient s/s CVA
Compared to customary care CIMT significantly improves outcomes
Associated changes in brain organization on functional MRI - so they showed actual changes in the brain - if they have any movement to start w/ they will have beenfits form this (and meat the other portions of the criteria)
Significant functional gains
Hundereds of studies-most with positive results
Early studies patients with chronic stroke > 1 year
Adherence-Enhancing Behavioral strategies - need to meet these behavior stratgies for the contraint induced therapy
* Daily administration of motor activity log
* Home diary
* Problem-solving to overcome apparent barriers to use of the more affected UE in the real world situation
* Behavioral contract
* Caregiver contract
* Written home skill assignment with check off list
* Home practice
* Daily schedule
* phone calls and text messages
Constraint-Induced Therapy in Children with Hemiparesis
* Age appropriate activities that sustain interest for long periods
* Duration and type of restraint must be modified
* Studies range form 6 months to 18 years
* Nearly all studies reported positive outcomes
* Diversity of approaches
* No evidence suggests that one type of restraint is more effect than another
* Improvements in UE performance in young children have been noted with just 2 hours per day three times per week
* Repeated doses of CIMT have been shown to have an additive effect
* Can be considered as part of a childs long term therapy
So need to be worried about a little kids brain mapping
* also if they dont understand why you’re doing it than they might be upset - need to understand why
how we constrain children
* Cast
* Splint
* Ace wraps
* Protective mitt
CIMT and motor learning principles
* Both part and whole practice methods
* Modifying tasks to ensure success and progression of difficulty as success is achieved
* Active problem solving
* Optimal practice and feedback schedules
* Need to generalize learning to performance in everyday environments
* Children must overcome developmental disuse- may need to learn how to use UE for the first time
* Developmentally focused - so brain mapping might not even be intact for the kid - especially if they’ve never used that arm before
Pediatric CIMT
* potentially psychologically and physically invasive - they might not understand why you’re doing it
* Use of less affected side still developing
* Restriction of limb use early reduces topograhic distribution
* Risk of damage to the less affected UE if restrained for long periods at too early an age (because of the brain maping)
* Modified protocol is required in young children
* Focuses on unimanual impairments, which do not greatly influence functional independence and uality of life
* training likely improves manual desterity lacks specificty for how hand will be used as nondominant assisting hand during bimanual activities
* Children with hemiplegia have impairments in spastial and temporal coordination of the two hands, as well as global impairments in motor planning CIMT does not address
Salience of Motor actvities
* Activities that are meaningful and enjoyable including video games (remember, these dont help w/ developmental coordination disorder)
* Age of child and preferred tasks
* Family activities and family values
* Attention span
* Use of virtual reality-based and video gaming protocols is gaining momentum in rehab
Conditions Appropriate for CIMT
* S/P CVA
* AVM
* S/P AVM rupture
* Brain Tumor (with or without resection)
* Cerebral Palsy
* Any diagnosis with hemiparesis with neural recovery possible
* Brachial Plexus injury (not at birth)
measure of finger dextarity
only hand being evaulated gets to move pegs - can use the other hand to stabilize
trying to do everything on the log everyday w/ constrained therapy
