What are the benefits and how can CIMT help?
By: Sarah Karmali MS, OTR/L
Constraint Induced Therapy [CIT] helps the brain “rewire” itself (Constraint-induced Therapy (CI Therapy) Taub Therapy clinic, n.d.) by integrating activities using the affected limb rather than the non-affected limb. CIT can show improvements with the affected hand regardless of the date of injury. The first human study of CIT was done in 1993 at The University of Alabama Medicine by Dr. Edward Taub, PhD and his research group. Since then, many studies have been done on the benefits of CIT and how it helps improve bilateral integration in adults and children who have experienced “TBIs, strokes, brain tumors, or multiple sclerosis” (Constraint-induced Therapy (CI Therapy) Taub Therapy clinic, n.d.).
According to a study done by DeLuca, Ramey, Trucks, and Wallace (2015), 28 children used constraint induced movement therapy, [CIMT] which involves construction of “full arm-to-fingers lightweight cast worn continuously during the first 18 days of a 20-21 day treatment over 4 weeks (DeLuca et al., 2015, p. 3) on their non-affected arm. Therapists used successive approximations (shaping), which is gradually giving the child more complex activities while in the cast, which allows the child to feel successful throughout the experience. The therapist then was able to use clinical reasoning if maximum physical assistance was needed to allow for the child to feel successful in the beginning. After the child showed success with shaping, habit training (repetitive participation in an activity) was initiated and rewards (token economy) were given to the child. When the child was able to participate in most of the activities at 70-80% success rate, the therapist gradually eliminated support, rewards, and made activities more challenging. Additionally, the therapist started working on other sets of skills but still incorporated tasks that were enjoyable to the child. The last few days of treatment included taking off the cast and participating in bilateral integration activities. After treatment, home therapy was incorporated to help the child engage in their daily environment. The results of the study showed that children made significant gains and showed emerging behaviors with their affected extremity after their first treatment with CIMT. There were children who displayed declines in skills post treatment, which suggests supports such as a home-exercise plan and other physical supports should be given in the future (DeLuca et al., 2015).
Similarly, Wu, Hung, Tseng, and Huang (2013), studied the benefits of CIMT on a group of 8 children with hemi-plegia over 4 weeks, 5 days of the week, for 2.5 hours of the day. Each child who participated in the study wore a “thermoplastic short upper-extremity splint on the less affected upper-extremity during the intervention session” (Wu et al., 2013, p. 203). Each treatment session consisted of stretching, weight-bearing, “hand function activities, eating and drinking activities and games” (Wu et al., 2013, p. 203) using the affected extremity, with breaks in between. Similar to the previous study mentioned, this study also used shaping and habit training to allow for confidence and success with participants. In comparison to the previous study, this study informed parents to have the child wear their splint at home post treatment. The results of the study support group based CIMT for children “with hemiplegic cerebral palsy in a clinical setting” (Wu et al., 2013, p. 204), displayed “significant gains in manual performance of the affected upper-extremity and self-care function post intervention,” (Wu et al., 2013, p. 204) and “The spontaneous use of the affected upper-extremity also increased” (Wu et al., 2013, p. 204).
Similar to previous studies mentioned, Smith, DeLuca, Stevenson, Ramey (2012), incorporated shaping and casting in their study. The casting incorporated using a long-arm splint with the elbow at 90 degrees flexion. This study looked at the benefits of 3 hour a day vs. 6 hour/day of CIMT and included follow-up at 6 months. The results stated that children did not receive better results when participating in CIMT for 6 hours a day and that 3 hours a day would be sufficient. It should be understood that young children have limited focus and energy to maintain CIMT for 6 hours a day. Results of participating in CIMT training were slightly lower for participants at their 6 month follow-up compared to post intervention, but over-all results were positive (Smith et al., 2012).
In conclusion, CIMT focuses on the child using their affected arm to participate in meaningful occupations and in turn allowing for increased bilateral integration skills post cast removal. The studies provided show that CIMT displays positive results such as, children using their affected arm more spontaneously and functionally after the cast is removed.
References
Case-Smith, J., DeLuca., S. C., Stevenson, R., & Ramey, S. L. (2012). Multicenter randomized controlled trial of pediatric constraint-induced movement therapy: 6-month follow-up. American Journal of Occupational Therapy, 66(1), 15–23.
Constraint-Induced Therapy (CI Therapy) Taub Therapy Clinic. (n.d.). Retrieved from
https://www.uabmedicine.org/patient-care/treatments/ci-therapy
DeLuca, S. C., Ramey, S. L., Trucks, M. R., & Wallace, D. A. (2015). Multiple treatments of pediatric constraint-induced movement therapy (pCIMT): A clinical cohort study. American Journal of Occupational Therapy, 69(6),1-9.
Wu, W.-C., Hung, J.-W., Tseng, C.-Y., & Huang, Y.-C. (2013). Group constraint-induced movement therapy for children with hemiplegic cerebral palsy: A pilot study. American Journal of Occupational Therapy, 67(2), 201–208.
