Constraint Induced Movement Therapy
What is CIMT?[edit | edit source]
Constraint Induced Movement Therapy (CIMT) is a new treatment technique that claims to improve the arm motor ability and the functional use of a paretic arm - hand. CIMT forces the use of the affected side by restraining the unaffected side. Child with hemiplegic cerebral palsy can learn to improve the motor ability of the more affected parts of their bodies and thus cease to rely exclusively or primarily on the less affected parts.[1]
In the original concept, the less affected arm-hand was immobilized in a sling[2] [3], but soon an emphasis on intensive, repetitive training (massed practice) of the more affected arm- hand evolved. In the current application of the method, the patients wear a mitt on the less affected arm 90% of their waking hours and perform repetitive exercises with the more affected arm six to seven hours per day during two to three weeks [4] [5].
History of CIMT[edit | edit source]
CIMT therapy is based on research by Edward Taub, Ph.D. and collaborators at the University of Alabama. The idea of CIMT therapy was developed due to the initial unsuccessful use of the affected limb. Dr. Taub hypothesize that the non-use was a learning mechanism and calls this behavior “Learned non-use”. [6]
The learned non-use phenomenon: It was observed that patients with hemiparesis did not use their affected extremity (hemi-neglecting) [7] . Taub and colleagues have investigated this phenomenon using basic research on monkeys. When one of the two forelimbs was deafferented, the animal stopped using the affected extremity. Taub et al concluded that the pattern with three-limb use, initially necessary after the spinal chock, was positively reinforced, whereas attempts to use the deafferented forelimb resulted in incoordination and failures [8]. It was postulated that the monkeys did not use the limb due to “learned non use”, or learned behaviour suppression. By immobilizing the intact arm for a period of consecutive days (1-2 weeks), the monkey started to reuse the deafferented forelimb again and “the learned non-use” was overcome [9]
- ↑ A Rehab Revolution. Stroke Connection Magazine. December 23, 2010. Retrieved July 25, 2011.
- ↑ Wolf S., Lecraw D., Barton L., Jann B. (1989). Forced use of hemiplegic upper extremities to reverse the effect of learned nonuse among chronic stroke and head-injured patients. Exp. Neurol. 104 125–132
- ↑ Taub E., Miller N. E., Novack T. A., Cook E. W., 3rd, Fleming W. C., Nepomuceno C. S., et al. (1993). Technique to improve chronic motor deficit after stroke. Arch Phys Med Rehabil, 74(4), 347-354.
- ↑ E. Taub, S.L. Wolf. (1997). Constraint induced movement techniques to facilitate upper extremity use in stroke patients. Topics in Stroke Rehabilitation, 3, pp. 38–61
- ↑ Taub E, Uswatte G and Elbert T (2002). New treatments in neuro rehabilitation founded on basic research. Nature Reviews Neuroscience (3) 226-236.
- ↑ Taub E., Uswatte G.(2009). Constraint-induced movement therapy: A paradigm for translating advances in behavioral neuroscience into rehabilitation treatments. In: Berntson G., Cacioppo J., editors.Handbook of neuroscience for the behavioral sciences (Vol. 2, pp. 1296–1319) Hoboken, NJ: Wiley; 2009. (Eds.)
- ↑ Levin P and Page SJ (2004). Modified constraint-induced therapy: a promising restorative outpatient therapy. Top Stroke Rehabil (11) 1-10.
- ↑ Taub E, Bacon RC and Berman AJ (1965). Acquisition of a trace-conditioned avoidance response after deafferentation of the responding limb. J Comp Physiol Psychol (58) 275-279.
- ↑ Taub E (1980). Somatosensory deafferentation research with monkeys: implications for rehabilitation medicine. In Ince LP, ed. Behavioral Psychology in Rehabilitation Medicine, Clinical Applications, Baltimore: William and Wilkins 371- 401.
