Evidence reviewed as of before 01-01-2021 Author(s): Ogourtsova, T. (PhD OT); Steven, E. (MSc App OT); Iliopoulos, G. (MSc App OT); Deleva, V. (MSc App OT) & Majnemer, A. (PhD, OT, FCAHS)

Introduction

Use of the weaker arm is promoted during play by constraining the dominant limb. Accessed on June 28, 2022 from https://scottishriteforchildren.org/news-items/a-collaborative-research-program-advances-care-for

Constraint Induced Movement Therapy (also referred to as CI, CIT or CIMT) was first developed for adults who suffered strokes, to improve the function of their most affected upper limb. It has been used in other adult populations, such as traumatic brain injury and focal hand dystonia, and later with pediatric populations, such as hemiplegic cerebral palsy (CP). All of these populations present with weakness, poor muscular control and sensory impairments affecting one side of their body. Often, people with these difficulties learn that it is more effective to use their unaffected limb, ignoring their affected arm in daily activities. By doing this, ‘learned non-use’ of the affected arm occurs, which can worsen impairment.

CIMT attempts to change the behavioral aspect of ‘learned non-use’ by creating the opportunity, experience and environment in which a person can learn how to use their affected limb. CIMT involves 3 main strategies: 1) the prolonged constraint of the non-affected limb (usually by a mitt, sling, or splint); 2) intensive repetitive practice of motor activities with the affected limb; 3) breaking down a goal into smaller functional movements and rewarding even approximations until the target task is achieved.

Modified CIMT (mCIMT) was developed as a more child-friendly approach with its main difference being the frequency and duration of a restraint wearing schedule (e.g. shorter wearing schedule with longer period of intervention). Compared to traditional CIMT which asks a person to wear a restraint device 90% of waking hours (approximately 13 hours/day) for a 2-week period, mCIMT is done for fewer hours per day (usually 3 hours total with only 30 min at a time) but for more weeks.

Parent & Family Information

Clinician Information

Infants with unilateral CP

CP level N/A

Children with unilateral CP

GMFCS level I-III; MACS level I-IV

GMFCS level I-II; MACS level I-III

GMFCS level I-III

CP Level N/A

References

  • Aarts, P. B., Jongerius, P. H., Geerdink, Y. A., van Limbeek, J., & Geurts, A. C. (2010). Effectiveness of modified constraint-induced movement therapy in children with unilateral spastic cerebral palsy: a randomized controlled trial. Neurorehabilitation and neural repair24(6), 509–518. https://doi.org/10.1177/1545968309359767

  • Chamudot, R., Parush, S., Rigbi, A., Horovitz, R., & Gross-Tsur, V. (2018). Effectiveness of Modified Constraint-Induced Movement Therapy Compared With Bimanual Therapy Home Programs for Infants With Hemiplegia: A Randomized Controlled Trial. The American journal of occupational therapy : official publication of the American Occupational Therapy Association72(6), 7206205010p1–7206205010p9. https://doi.org/10.5014/ajot.2018.025981

  • Christmas, P. M., Sackley, C., Feltham, M. G., & Cummins, C. (2018). A randomized controlled trial to compare two methods of constraint-induced movement therapy to improve functional ability in the affected upper limb in pre-school children with hemiplegic cerebral palsy: CATCH TRIAL. Clinical rehabilitation32(7), 909–918. https://doi.org/10.1177/0269215518763512

  • Deluca, S. C., Echols, K., Law, C. R., & Ramey, S. L. (2006). Intensive pediatric constraint-induced therapy for children with cerebral palsy: randomized, controlled, crossover trial. Journal of child neurology21(11), 931–938. https://doi.org/10.1177/08830738060210110401

  • Eliasson, A. C., Nordstrand, L., Ek, L., Lennartsson, F., Sjöstrand, L., Tedroff, K., & Krumlinde-Sundholm, L. (2018). The effectiveness of Baby-CIMT in infants younger than 12 months with clinical signs of unilateral-cerebral palsy; an explorative study with randomized design. Research in developmental disabilities72, 191–201. https://doi.org/10.1016/j.ridd.2017.11.006

  • Facchin, P., Rosa-Rizzotto, M., Visonà Dalla Pozza, L., Turconi, A. C., Pagliano, E., Signorini, S., Tornetta, L., Trabacca, A., Fedrizzi, E., & GIPCI Study Group (2011). Multisite trial comparing the efficacy of constraint-induced movement therapy with that of bimanual intensive training in children with hemiplegic cerebral palsy: postintervention results. American journal of physical medicine & rehabilitation90(7), 539–553. https://doi.org/10.1097/PHM.0b013e3182247076

  • Gelkop, N., Burshtein, D. G., Lahav, A., Brezner, A., Al-Oraibi, S., Ferre, C. L., & Gordon, A. M. (2015). Efficacy of constraint-induced movement therapy and bimanual training in children with hemiplegic cerebral palsy in an educational setting. Physical & occupational therapy in pediatrics35(1), 24–39. https://doi.org/10.3109/01942638.2014.925027

  • Hoare, B., Imms, C., Villanueva, E., Rawicki, H. B., Matyas, T., & Carey, L. (2013). Intensive therapy following upper limb botulinum toxin A injection in young children with unilateral cerebral palsy: a randomized trial. Developmental medicine and child neurology55(3), 238–247. https://doi.org/10.1111/dmcn.12054

  • Taub, E., Ramey, S. L., DeLuca, S., & Echols, K. (2004). Efficacy of constraint-induced movement therapy for children with cerebral palsy with asymmetric motor impairment. Pediatrics113(2), 305–312. https://doi.org/10.1542/peds.113.2.305

  • Wallen, M., Ziviani, J., Naylor, O., Evans, R., Novak, I., & Herbert, R. D. (2011). Modified constraint-induced therapy for children with hemiplegic cerebral palsy: a randomized trial. Developmental medicine and child neurology53(12), 1091–1099. https://doi.org/10.1111/j.1469-8749.2011.04086.x

  • Xu, K., He, L., Mai, J., Yan, X., & Chen, Y. (2015). Muscle Recruitment and Coordination following Constraint-Induced Movement Therapy with Electrical Stimulation on Children with Hemiplegic Cerebral Palsy: A Randomized Controlled Trial. PloS one10(10), e0138608. https://doi.org/10.1371/journal.pone.0138608

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