Constraint-Induced Movement Therapy (CIMT): Current Perspectives and Future Directions

Abstract

<jats:p>Constraint-induced movement therapy (CIMT) has gained considerable popularity as a treatment technique for upper extremity rehabilitation among patients with mild-to-moderate stroke. While substantial evidence has emerged to support its applicability, issues remain unanswered regarding the best and most practical approach. Following the establishment of what can be called the “signature” CIMT approach characterized by intense clinic/laboratory-based practice, several distributed forms of training, collectively known as modified constraint therapy (mCIMT), have emerged. There is a need to examine the strengths and limitations of such approaches, and based upon such information, develop the components of a study that would compare the signature approach to the best elements of mCIMT, referred to here as “alternative” CIMT. Based upon a PEDro review of literature, limitations in mCIMT studies for meeting criteria were identified and discussed. A suggestion for a “first effort” at a comparative study that would both address such limitations while taking practical considerations into account is provided.</jats:p>

Early upper limb physiotherapy in stroke patients. Questions without answers

“…Nowoczesne metody fizjoterapeutyczne korzystają szczególnie z podejścia opartego na odtwarzaniu funkcji motorycznych, czyli przywracaniu w maksymalnie możliwy sposób stanu sprzed udaru [33,34]. W podejściu tym rozważane jest dążenie do wykonywania czynności w miarę możliwo-ści w ten sam sposób i z tą samą efektywnością i skutecznością, co przed udarem.…”

“…Taka strategia wydaje się szczególnie istotna we wczesnym okresie po udarze. W badaniach klinicznych niektóre rodzaje terapii wydają się efektywniejsze niż rehabilitacja konwencjonalna, co jest często spowodowane większą ilością terapii zastosowanej w grupie eksperymentalnej [34]. Liczne badania porównują różne "szkoły interwencji terapeutycznych".…”

“…Modern physiotherapeutic methods are mainly based on reproducing motor functions, i.e. trying to return to a pre-stroke state as much as possible [33,34]. This approach focuses on striving, as far as possible, to perform activities in the same way and with the same effectiveness and efficiency as before stroke.…”

Practice-based evidence from a clinical cohort that received pediatric constraint- induced movement therapy

“…Often there is a need to determine the extent to which the originally tested treatment protocol is followed in clinical practice and the extent to which variations in key components of the treatment protocols contribute to differential outcomes in patient populations. For the adult CIMT intervention, developed for patients secondary to stroke, Reiss et al [10] proposed that variations in protocols could be classified as signature forms if they are of much higher intensity and specify more directly how to use reinforcement and shaping methods and as modified forms when of lesser intensity and therapy specificity. For the field of pediatric CIMT, Ramey, Coker-Bolt, and DeLuca [3,11] proposed a similar designation and identified five core treatment components: 1) constraint of the unimpaired or less impaired arm and hand; 2) relatively high dosage therapy consisting of many treatment hours each day and multiple days per week; 3) use of operant conditioning techniques (reinforcement, shaping through successive approximations) and massed practice to promote motor learning; 4) providing therapy in a natural environment; and 5) a post-CIMT transition plan.…”

Multiple Treatments of Pediatric Constraint-Induced Movement Therapy (pCIMT): A Clinical Cohort Study

“…Like most pediatric therapy models, pCIMT is individualized with goals and activities to match the child's current skill levels and developmental needs (Case-Smith, 2013;Case-Smith & O'Brien, 2010). The protocol used in this study matches the "signature form" of pCIMT Ramey, DeLuca, & Coker-Bolt, 2013;Reiss, Wolf, Hammel, McLeod, & Williams, 2012).…”