CIMT involves constraining the unaffected limb, along with intense therapy, in order to force the use of the affected limb with intent to improve motor function.

1. Constraint Induced
Movement Therapy
- Nidhi Chhabra

2. Objective

3. Introduction
• CIMT involves constraining the unaffected
limb, along with intense therapy, in order to
force the use of the affected with the intent
to improve motor function.

4. History
• Early research was done by Edward Taub on
surgically deafferented monkeys.
• “learned non-use”.

5. • 3 components of CIMT
– Restraint of unaffected arm.
– Repetition, structured, intense practice of
affected arm.
– Monitored arm used in life situation and
problem solving to overcome barriers.

6. Technique
• Types of restraint included
• Sling
• Glove
• Splint
• Plaster
• Total time of restraining – 90% of waking hours.
• 6 hours/day of intense therapy on consecutive weekdays.
• 2 to 3 week period.

7. • Minimum inclusion criteria
– Upto 20 degree wrist extension
– Upto 10 degree thumb abduction
– Upto 10 degree finger extension.

8. Advantages Disadvantages
Overall great improvements in
function as compared to conventional
treatment.
Requires enormous labour.
Highly researched treatment
approach.
Patient endures many hours of
frustration.
Increased social participation. Patient can suffer from muscle
soreness resulting in stiffness and
discomfort in the involved UE as well
as skin lesions.
Cortical reorganisation observed. Not beneficial for all stroke or head
injury patients.

9. Evidence
STUDY YEAR AUTHOR PATIENT RESULT
RCT 2000 Dromeric A.W,
Edwards D.F,
Hahn M
Acute stroke
patients
CIMT was
associated with
less arm
impairment at
the end of
treatment.
RCT 2002 Edward. T et al Children with
Hemiparesis CP
Major and
sustained
improvement in
motor
functions.
RCT 2006 Wolf S. et al 3-9 months
after stroke
Clinically
relevant
improvement
seen persisting
for at least 1
year.

10. STUDY YEAR AUTHOR PATIENT RESULT
RCT 1998 Wolfgang. H et
al
Chronic stroke
patients, UE
motor deficits
Intervention
had general
applicability.
RCT 2007 Boake et al Subacute
stroke patients
CIMT has little
difference on
overall
outcome in
motor
movements.
Meta-analysis 2010 Corbetta. D et
al
All RCTs and
Quasi RCTs
from Jan 2009
to April 2010
included
Majority of
studies were
underpowered
and imprecise,
exposing the
analysis to
small-study
bias. Large
RCTs needed to
resolve the
uncertainties.

11. Modified CIMT
• To promote better compliance.
• Protocol :
– 30 mins of 1 to 1 therapy for 3 days a
week;
– 5 hours/day in restraint (weekdays) for 10
weeks.

12. Modified CIMT
• To promote better compliance.
• Protocol: 30 mins of 1 to 1 therapy,
3 days/ week,
5 hours/day in restraint (weekdays)
10 weeks .
Take home
message

13. References
• Constraint Induced Movement Therapy, Psych
428, May 2008.
• Constraint Induced Movement Therapy: A
New Family of Techniques with Broad
Application to Physical Rehabilitation- A
Clinical Review, Edward Taub et al.
• www.ncbi.nlm.nih.gov/pubmed.
• www.scholar.google.co.in.

14. Thank you !