Baby-CIMT (Constraint Induced Movement Therapy for infants)
What is baby-CIMT?
Constraint induced movement therapy (CIMT) is a well-researched treatment approach for children with hemiplegia above the age of 18 months. Baby-CIMT is a modification of CIMT, adapted to infants and babies under the age of 18 months who are at risk of developing hemiplegic cerebral palsy (CP).
Baby-CIMT is characterized by the same factors of CIMT:
- Constraint of the stronger arm and hand
- Intensive structured training of the affected hand involving repetition
- Challenging yet achievable task-oriented activities
- Positive feedback and encouragement to reinforce motor learning
Its main purpose is to increase the use of the affected hand, by giving the child numerous opportunities to repeat tasks with the affected hand, so that its development keeps up with that of the non-affected hand. To achieve this, some form of restraint for the non-affected hand is used during therapy time. Children are encouraged and stimulated to use their affected upper limb through play and exploration of their everyday environment and toys, and this is something that can be carried out by parents, under the supervision of a therapist.
Early intervention is important because learning-induced brain plasticity at an early age seems to have a unique impact on brain development. Baby-CIMT takes advantage of the plastic properties of the young developing brain, and our knowledge around activity-dependent cortical reorganization, and aims to influence the development of the child’s hand function. Two of the key elements of motor learning, are repetition and positive feedback. Babies are very sensitive to encouragement and learn skills through the encouragement and responses they get from their parents.
There are no official guidelines yet regarding the intensity, dosage, and starting age of baby-CIMT. In the most recent study, it is recommended that baby-CIMT start when asymmetric hand use is first observed (usually around the age of 3-5 months). Training should start when the baby begins to show an interest in objects around them, trying to explore and grasp them. Eliasson states: “At an early age, it can be difficult to know if the asymmetric hand function will lead to unilateral CP or disappear. However, training provided in an appropriate way will not harm any child’s development”.
There is currently very limited evidence on the effect of baby-CIMT. The reason for this is that it is a relatively new form of therapy for children this young and it is still being investigated. Some of the main obstacles to conducting early intervention studies with infants include the unclear diagnosis and lack of tools for assessing the development of hand function at such an early age. A retrospective study in 2015 comparing hand function of two year old children who received baby-CIMT and children who didn’t, found that the children who received baby-CIMT were six times more likely to have a high functional level at the age of two, than the children that did not receive the treatment. The most recent explorative study carried out in 2018 used a training dosage of 36 hours in total, split into two periods of six weeks, during which the babies had a constraint on their non-affected hand for 30 minutes per day and received therapy during this time. Compared to baby-massage, the children receiving baby-CIMT showed a significant improvement in unimanual abilities on the Hand Assessment for Infants (HAI).
Conclusion & Clinical implications
In agreement with the results of CIMT studies in older children, baby-CIMT appears to have a positive influence on the early development of hand function and might even be beneficial for later development of hand function. The limited research that is available to us shows that there is some evidence that baby-CIMT is effective, however more research is needed. Further clinical trials need to explore the effectiveness of baby-CIMT compared to other forms of early intervention therapy, the optimal dosage, intensity, and starting ages, as well as the long term-effects of baby-CIMT. It is important to note that no adverse effects were reported in any studies by therapists or parents.
References & further reading
- Basu, A. P., Pearse, J., Kelly, S., Wisher, V., & Kisler, J. (2015). Early intervention to improve hand function in hemiplegic cerebral palsy. Frontiers in neurology, 5, 281.
- 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 disabilities, 72, 191-201.
- Nordstrand, L., Holmefur, M., Kits, A., & Eliasson, A. C. (2015). Improvements in bimanual hand function after baby-CIMT in two-year old children with unilateral cerebral palsy: A retrospective study. Research in developmental disabilities, 41, 86-93.
- Krumlinde‐Sundholm, L., Ek, L., & Eliasson, A. C. (2015). What assessments evaluate use of hands in infants? A literature review. Developmental Medicine & Child Neurology, 57(s2), 37-41.
- Krumlinde‐Sundholm, L., Ek, L., Sicola, E., Sjöstrand, L., Guzzetta, A., Sgandurra, G., & Eliasson, A. C. (2017). Development of the Hand Assessment for Infants: evidence of internal scale validity. Developmental Medicine & Child Neurology, 59(12), 1276-1283.
- Chiu, H. C., & Ada, L. (2016). Constraint-induced movement therapy improves upper limb activity and participation in hemiplegic cerebral palsy: a systematic review. Journal of physiotherapy, 62(3), 130-137.
- Eliasson, A. C., Krumlinde‐Sundholm, L., Gordon, A. M., Feys, H., Klingels, K., Aarts, P., & Hoare, B. (2014). Guidelines for future research in constraint‐induced movement therapy for children with unilateral cerebral palsy: an expert consensus. Developmental Medicine & Child Neurology, 56(2), 125-137.