Contraint induced therapy

[saravanaphysi]

Hi all
Hope many of you would have come across regarding Constraint Induced therapy. Could anyone inform me about the drawbacks of this therapy and if possible with any literature evidence
Thanks

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[sdkashif]

Constraint-induced movement therapy (CIT) is a family of therapies that induce patients who have had a stroke to greatly increase the amount and quality of movement of their paretic limb, in turn improving function. CIT is based on the theory of "learned nonuse," first described by Wolf and later by Taub. Following substantial neurological injury, a shocklike phenomenon, called diaschisis, results in a dramatically depressed condition of motor neuron function. During this shock period, the patient is unable to move the affected limb and subsequently learns to compensate with the functional limb. As the shock resolves and function starts to improve, attempts to use the affected limb result in clumsy and ineffective movements that positively reinforce continued compensation.

Treatment begins by restraining the functional limb during all waking hours, except for specified activities, and then forcing the patient to perform tasks almost exclusively with their paretic limb for up to 2 weeks. This usually produces measurable improvement of function in the paretic limb, as well as increases in speed and strength of contraction, provided some selective hand movement (slight wrist and finger extension), good balance, and good cognitive and communication skills are present.

As reported by Morris, a behavioral training technique called shaping often is used in conjunction with CIT. Shaping has resulted in substantial improvement of motor function. Shaping approaches a desired motor outcome in small successive steps through explicit positively reinforced feedback by the therapist. This allows subjects to experience successful gains in performance with relatively small amounts of motor improvement. A battery of approximately 60 tasks has been developed with a preliminary shaping plan for each task. Each task can be broken down into subtasks. Performance regressions are never punished and usually are ignored. If performance continues to exhibit no improvement after approximately 3 trials, the subject is encouraged to improve further at a later time, a simpler subtask is attempted, or an entirely different task is substituted. Eventually, an individualized task-oriented home program that emphasizes the use of the most impaired movements and joints is established.

Patients tend to reach a plateau in motor recovery within 6-12 months following stroke. Compared to an attention-comparison group, the restrained subjects improved on each measure of motor function (ie, performance time, quality of movement, range of activities); in most cases, patients improved markedly. Two-year follow-up revealed that ADL functions had been maintained or increased. The use of CIT proved to be an effective means of restoring substantial motor function in chronic stroke patients.

For more information resources see

Constraint-induced movement therapy for focal hand dystonia in musicians

Constraint-Induced Movement Therapy (CIMT): Strong Evidence Supportive of the Habit Retraining Model

Constraint-Induced Therapy: Ready for Prime Time?

What Is CI Therapy?

Reference:

Morris DM: Constraint-Induced Movement Therapy for Motor Recovery After Stroke. NeuroRehabil 1997

[saravanaphysi]

Thanx for the information but i am in need of the drawbacks of this study since all the literatures are dealing only with the benefits of CI therapy. I also want to know if any physios have used this therapy successfully though there would have been few drawbacks.
However, the information given is definitely useful for many physio's who have'nt heard about CI therapy since the rationale behind this therapy is very amazing!!!

[jebapt]

Few Draw backs of CIMT :
#Attempted movements on affected side might leads to abnormal synergy patterns as Patient tries to accomplish the task there is always high risk of trick movements which may lead to some complex synergy patterns..

#Irradiation of nerve impulses during activity may lead to fatigue which in turn may leads to increase in spasticity..

#Mental burn out among Patients is quite common, as normal limb movements are restricted.. which in turn has effect on tone..

#Restriction of normal arm leads to lack of arm swing which inturn aggaravates gait deviations..

#The loss of independence that results from having to wear a sling during all waking hours for two weeks.

#The therapy has only been shown to be effective with patients exhibiting some movement in the fingers and/or wrist(Role of CIMT in Acute Stroke????)

# Role of CIMT in Middle Cerebral Artery is limited, as Upper limb recovery is very less..

# The intensity of CIMT is not feasible in the typical rehabilitation environment, nor is it reimbursable within our current health care system

# Role of CIMT with chronic stroke patients with long duration over 2 years ??? because much of the observed cortical reorganization following stroke occurs during the first six months...

# If the patient's Non Dominant extremity is affected.. then the role of CIMT is definetely questionable..

[Rajul vasa]

I am copying to paste the following, i read in;

REHABILITATION CLINICAL TRIALS

Modified Constraint-Induced Therapy in Sub-Acute Stroke: A Pilot Study
Principal Investigator: Sue Ann Sisto, Ph.D., P.T

However, these CI studies are limited in their application for several reasons: (1) the intensity of this therapy is not feasible in the typical rehabilitation environment, nor is it reimbursable within our current health care system; (2) no CIT studies with sub-acute stroke patients have reported the functional outcomes of stroke patients using a validated functional outcome measure; (3) the functional tasks measured have not been ones necessarily most meaningful to patients; (4) only one published CIT study has employed randomized, controlled methods with a number of subjects that would produce appropriate power; and (5) previous studies have employed CIT with chronic stroke patients although much of the observed cortical reorganization following stroke occurs during the first six months.

[mansourhabiballah]

Hi all
Hope many of you would have come across regarding Constraint Induced therapy. Could anyone inform me about the drawbacks of this therapy and if possible with any literature evidence
Thanks

hiiii im mansour habiballah 4th year on physical therapy studying me too im searching for material about constraint induced movment therapy cuz i have to do presentation about this subject then i have some material :
cimt is nea techique for stroke patients espacially to regain functions on upper extrimities .
if u like material tell me .
[email protected]

[basbana]

Could someone explain the concept of Cortical Reorganization to me? From what I understand is that each movement is controlled by a part of the cerebral cortex and when that part is damaged, another part of the cerebral cortex takes on that movement. Am I correct in this?

thanks!

[Fyzzio]

Hi,
not quite that easy. Suggest you search "Neuroplasticity".


Brain 2008 131(5):1381-1390
Priming the motor system enhances the effects of upper limb therapy in chronic stroke
Cathy M. Stinear, P. Alan Barber, James P. Coxon, Melanie K. Fleming and Winston D. Byblow

Regards,
Physio