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Constraint-induced movement therapy (CIMT) is an intervention that has proven to be effective for improving motor skills in children with unilateral spastic cerebral palsy. CIMT consists of three key elements: intensity, restraint and shaping. This intervention is currently being used in many centers as a form of rehabilitation therapy for children with cerebral palsy.
Restraint of the well-functioning upper limb for almost all waking hours for a minimum of 2 weeks, which is accompanied by intensive training of the involved upper limb for at least 3 hours per day.
Restraint and intensive training are included in this model of delivery however certain features vary, including the type of restraint of the non-affected upper limb, the type of structured training provided, program duration and length and the location, context and provider of training.
The key components of mCIMT are utilized and are also accompanied by bimanual training.
Restraining of the well-functioning hand/arm but not accompanied by a structured training program.
Source: Eliasson, A., Krumlinde-Sundholm, L., Gordon, A., Feys, H., Klingels, K., Aarts, P., et al. Guidelines for future research in constraint-induced movement therapy for children with unilateral cerebral palsy: an expert consensus. Developmental Medicine & Child Neurology 2014; 56: 125-137.
Positive evidence was found for improved hand use after CIMT, particularly from the less-rigorous study designs.
A randomized controlled trial of 18 children with hemiplegia did not reveal any statistically significant results on the QUEST-Dissociated Movement subscale. However a trend in favor of the CIMT group was demonstrated.
this article also discusses the therapists’ role in ensuring minimal frustration levels experienced by clients thus maximizing the benefits of CIMT program by offering compensations and adaptations.
The authors conclude that both interventions lead to increase in occupational performance, however, to truly address participation, an intervention addressing environmental, attitudinal and child-related factors would need to be developed.
All participants demonstrated a trend for positive change in upper limb function after intervention. This study also demonstrates that most positive results were yielded with intensive therapy than as compared to traditional therapy delivery.
All participants demonstrated a trend for positive change in upper limb function after intervention. This study also demonstrates that most positive results were yielded with intensive therapy than as compared to traditional therapy delivery.
This app can help “provide effective, goal-directed upper limp therapy for young children with cerebral palsy”. By selecting certain criteria, the app will help match toys or activities that are perfectly suited to your child’s therapeutic needs!
Designed for children with mild to moderate impairment of the hemiplegic hand, with active shoulder, elbow and wrist movements. All children must be independent ambulators without the use of assistive devices.
This article details an 8-week protocol that combines a modified constraint-induced movement therapy protocol combined with task-specific bimanual training.
For activities that required two hands, the adolescents were asked to cooperate with each other. Results showed that all participants had improved dexterity, coordination, precision and manipulative abilities at the end of camp. These improvements were maintained 5 months post camp cessation.
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This handbook provides an integrative history about CIMT that includes its major research findings, theoretical underpinnings, practical guidelines for practitioners and health care providers, and peer-reviewed information for students preparing to be pediatric practitioners and educators.
Intervention and program guidelines for creating and/or maintaining intensive upper extremity programs.
This assessment measures how well the affected hand is used in conjunction with the non-affected hand to accomplish bimanual activities. Extensive training and certification is required in order to perform this assessment.
Criterion-referenced measure of change in which each individual identifies personalized functional goals and specify a range of outcomes which are then rated on a 5-point scale of attainment.
Individualized, client-centered outcome measure in which individuals identify personal goals based on restrictions in everyday living performance. These goals are rated in terms of importance, performance and satisfaction with performance.
Used to grade muscle tone.
This observational assessment measures quality of movement in both upper extremities. Results are divided into four categories which include: dissociated movements, grasps, weight bearing and protective extension.
This assessment rates quality of movement in the affected limb based on range, accuracy, dexterity and fluency of movements.
Unilateral measure of speed and dexterity. Used commonly in studies involving children with cerebral palsy, however, further psychometric testing is warranted.