Constraint Induced Movement Therapy (CIMT) is an evidence-based rehabilitation technique for improving motor function in patients with neurological impairments. It involves restraining the less impaired limb while intensively training the more impaired limb for several hours per day. The theory is that this reverses "learned non-use" of the impaired limb. Studies show CIMT results in cortical reorganization and significantly improves arm function and real-world use in both adults and children with conditions like stroke and cerebral palsy. While effects are positive, CIMT does not restore normal movement and its benefits gradually reduce after treatment ends.
Constraint Induced Movement Therapy (CIMT) is an evidence-based rehabilitation technique for improving upper limb function after stroke or cerebral palsy. It involves restraining the unaffected limb while intensively training the affected limb for several hours per day. Studies show CIMT leads to cortical reorganization and improved real-world arm use. The key elements are restraint of the less affected side and intensive task-specific training of the affected side. CIMT protocols have been developed for both adults and children with varying durations and intensities depending on the individual. Long-term follow up studies show benefits can persist for years after treatment.
constraint induced movement therapy.pptxibtesaam huma
Constraint induced movement therapy
Dr. Quazi Ibtesaam Huma (MPT)
Dr. Suvarna Ganvir (Phd, Prof & HOD)
Dept. of Neurophysiotherapy
DVVPF’s College of Physiotherapy
Content
Introduction
History of CIMT
Components of CIMT
Population for CIMT
Advantages of CIMT
Recent advances
Introduction
History of CIMT
CIMT is based on research by Edward Taub ,his hypothesize that the non use was a learning mechanism and calls this behavior “Learned non-use”.
It was observed that patients with hemiparesis did not use their affected extremity .
Overcoming learned non use
Mechanisms of CIMT
Population for CIMT
Stroke
Traumatic Brain Injury
Spinal Cord Injury
Multiple Sclerosis
Cerebral Palsy
Brachial Plexus Injury
Advantages of CIMT
Overall greater improvement in function than traditional treatment.
Highly researched and credible treatment approach.
There are brain activity and observed gray matter reorganization in primary motor, cortices and hippocampus.
Increase social participation
Components Of CIMT
Types of CIMT
Restraining Tools for CIMT
Minimal Requirement of hand function for CIMT
Recent Advances
The EXCITE Trial: Retention of Improved Upper Extremity Function Among Stroke Survivors Receiving CI Movement Therapy.(2008)
The Extremity Constraint Induced Movement Therapy Evaluation (EXCITE) demonstrated that CIMT administered 3-9 months post-stroke, resulted in statistically significant and clinically relevant improvement in upper extremity function during the first year compared to those achieved by participants undergoing usual and customary care.
This study was the first randomized clinical trial to examine retention and improvements for the 24 month period following CIMT therapy in a subacute sample.
Study design - single masked cross-over design, with participants undergoing adaptive randomization to balance ,gender, prestroke dominant side, side of stroke, and level of paretic arm function across sites.
CIMT was delivered up to 6 hours per day, 5 days per week for 2 weeks.
Subsequent evaluations were made after the two week period, and at 4, 8, and 12 months.
Because the control group was crossed over to receive CIMT after one year.
Primary outcome measures – Wolf Motor Function Test
Motor Activity Log
Secondary outcome measure - Stroke Impact Scale (SIS)
were assessed at each of these time intervals, was administered only at baseline, 4, 12, 16 and 24 month evaluations.
Result :There was no observed regression from the treatment effects observed at 12 months after treatment during the next 12 months for the primary outcome measures of WMFT and MAL.
In fact, the additional changes were in the direction of increased therapeutic effect. For the strength components of the WMFT the changes were significant (P < .05) Secondary outcome variables, including the SIS, exhibited a similar pattern.
Conclusion: Mild to moderately impaired patients who are 3-9 months post-stroke demonstrate
This document discusses postural control and balance. It defines key terms like static and dynamic balance, center of mass, center of gravity. It describes the different sensory systems, motor responses, and strategies involved in maintaining balance. Common balance impairments after stroke are described. Several clinical balance tests are mentioned. The principles of balance training include progressive challenge, use of feedback, and training functional tasks. Safety during balance training is also addressed.
Spina Bifida: Physiotherapy in the management of meningomyeloceleAyobami Ayodele
Spina bifida is a treatable spinal cord malformation that occurs in varying degrees of severity. Meningomyelocele is associated with abnormal development of the cranial neural tube, which results in several characteristic CNS anomalies. About 90% of babies born with Spina Bifida now live to be adults, about 80% have normal intelligence and about 75% play sports and do other fun activities. Most do well in school, and many play in sports.
The Bobath concept is an approach to treating mobility difficulties caused by neurological conditions like cerebral palsy and strokes. It was developed over 50 years ago by Bertha and Karel Bobath based on clinical experience and the neuroscience of the time. The Bobath approach uses specialized handling techniques to reduce abnormal tone and facilitate normal movements. Through positioning and handling, stiffness can be reduced and muscle control and movement improved. The overall aim is to enable better functioning in daily life.
Presentation slides from our recent workshop on Myofascial Release. This workshop was delivered from our St John Street Clinic in Manchester on Saturday 17th March.
Mirror therapy is a rehabilitation technique that uses visual feedback to improve motor function. During mirror therapy, a patient positions their unaffected limb in front of a mirror so that it is visually superimposed over the reflected image of the affected limb. This creates the illusion that both limbs are moving normally. Several studies have found mirror therapy to be effective at improving motor function, especially for patients recovering from stroke and Complex Regional Pain Syndrome. Combining mirror therapy with other interventions such as neuromuscular electrical stimulation may produce even greater functional gains.
The document discusses various facilitation and inhibition techniques used in physical therapy, outlining the theoretical basis, principles, receptors involved, differences between the techniques, guidelines for application, and clinical implications. It provides detailed descriptions of numerous proprioceptive and cutaneous facilitation techniques including quick stretch, tapping, joint compression, as well as inhibitory techniques like maintained stretch and cooling. The techniques aim to normalize muscle tone and facilitate or inhibit motor responses depending on a patient's needs.
Constraint Induced Movement Therapy (CIMT) is an evidence-based rehabilitation technique for improving upper limb function after stroke or cerebral palsy. It involves restraining the unaffected limb while intensively training the affected limb for several hours per day. Studies show CIMT leads to cortical reorganization and improved real-world arm use. The key elements are restraint of the less affected side and intensive task-specific training of the affected side. CIMT protocols have been developed for both adults and children with varying durations and intensities depending on the individual. Long-term follow up studies show benefits can persist for years after treatment.
constraint induced movement therapy.pptxibtesaam huma
Constraint induced movement therapy
Dr. Quazi Ibtesaam Huma (MPT)
Dr. Suvarna Ganvir (Phd, Prof & HOD)
Dept. of Neurophysiotherapy
DVVPF’s College of Physiotherapy
Content
Introduction
History of CIMT
Components of CIMT
Population for CIMT
Advantages of CIMT
Recent advances
Introduction
History of CIMT
CIMT is based on research by Edward Taub ,his hypothesize that the non use was a learning mechanism and calls this behavior “Learned non-use”.
It was observed that patients with hemiparesis did not use their affected extremity .
Overcoming learned non use
Mechanisms of CIMT
Population for CIMT
Stroke
Traumatic Brain Injury
Spinal Cord Injury
Multiple Sclerosis
Cerebral Palsy
Brachial Plexus Injury
Advantages of CIMT
Overall greater improvement in function than traditional treatment.
Highly researched and credible treatment approach.
There are brain activity and observed gray matter reorganization in primary motor, cortices and hippocampus.
Increase social participation
Components Of CIMT
Types of CIMT
Restraining Tools for CIMT
Minimal Requirement of hand function for CIMT
Recent Advances
The EXCITE Trial: Retention of Improved Upper Extremity Function Among Stroke Survivors Receiving CI Movement Therapy.(2008)
The Extremity Constraint Induced Movement Therapy Evaluation (EXCITE) demonstrated that CIMT administered 3-9 months post-stroke, resulted in statistically significant and clinically relevant improvement in upper extremity function during the first year compared to those achieved by participants undergoing usual and customary care.
This study was the first randomized clinical trial to examine retention and improvements for the 24 month period following CIMT therapy in a subacute sample.
Study design - single masked cross-over design, with participants undergoing adaptive randomization to balance ,gender, prestroke dominant side, side of stroke, and level of paretic arm function across sites.
CIMT was delivered up to 6 hours per day, 5 days per week for 2 weeks.
Subsequent evaluations were made after the two week period, and at 4, 8, and 12 months.
Because the control group was crossed over to receive CIMT after one year.
Primary outcome measures – Wolf Motor Function Test
Motor Activity Log
Secondary outcome measure - Stroke Impact Scale (SIS)
were assessed at each of these time intervals, was administered only at baseline, 4, 12, 16 and 24 month evaluations.
Result :There was no observed regression from the treatment effects observed at 12 months after treatment during the next 12 months for the primary outcome measures of WMFT and MAL.
In fact, the additional changes were in the direction of increased therapeutic effect. For the strength components of the WMFT the changes were significant (P < .05) Secondary outcome variables, including the SIS, exhibited a similar pattern.
Conclusion: Mild to moderately impaired patients who are 3-9 months post-stroke demonstrate
This document discusses postural control and balance. It defines key terms like static and dynamic balance, center of mass, center of gravity. It describes the different sensory systems, motor responses, and strategies involved in maintaining balance. Common balance impairments after stroke are described. Several clinical balance tests are mentioned. The principles of balance training include progressive challenge, use of feedback, and training functional tasks. Safety during balance training is also addressed.
Spina Bifida: Physiotherapy in the management of meningomyeloceleAyobami Ayodele
Spina bifida is a treatable spinal cord malformation that occurs in varying degrees of severity. Meningomyelocele is associated with abnormal development of the cranial neural tube, which results in several characteristic CNS anomalies. About 90% of babies born with Spina Bifida now live to be adults, about 80% have normal intelligence and about 75% play sports and do other fun activities. Most do well in school, and many play in sports.
The Bobath concept is an approach to treating mobility difficulties caused by neurological conditions like cerebral palsy and strokes. It was developed over 50 years ago by Bertha and Karel Bobath based on clinical experience and the neuroscience of the time. The Bobath approach uses specialized handling techniques to reduce abnormal tone and facilitate normal movements. Through positioning and handling, stiffness can be reduced and muscle control and movement improved. The overall aim is to enable better functioning in daily life.
Presentation slides from our recent workshop on Myofascial Release. This workshop was delivered from our St John Street Clinic in Manchester on Saturday 17th March.
Mirror therapy is a rehabilitation technique that uses visual feedback to improve motor function. During mirror therapy, a patient positions their unaffected limb in front of a mirror so that it is visually superimposed over the reflected image of the affected limb. This creates the illusion that both limbs are moving normally. Several studies have found mirror therapy to be effective at improving motor function, especially for patients recovering from stroke and Complex Regional Pain Syndrome. Combining mirror therapy with other interventions such as neuromuscular electrical stimulation may produce even greater functional gains.
The document discusses various facilitation and inhibition techniques used in physical therapy, outlining the theoretical basis, principles, receptors involved, differences between the techniques, guidelines for application, and clinical implications. It provides detailed descriptions of numerous proprioceptive and cutaneous facilitation techniques including quick stretch, tapping, joint compression, as well as inhibitory techniques like maintained stretch and cooling. The techniques aim to normalize muscle tone and facilitate or inhibit motor responses depending on a patient's needs.
The document describes the Motor Re-Learning Program (MRP), an approach to improving motor control after stroke. The MRP focuses on relearning daily activities through task-oriented practice and is based on theories of distributed motor control. The summary is:
1. The MRP involves analyzing tasks, practicing missing components, practicing whole tasks, and transferring learning to other contexts.
2. Intervention follows four steps - analyzing the task, practicing missing components, practicing the whole task, and transferring learning.
3. The program evaluates and improves functions like upper limb use, sitting, and walking through identifying normal movement and compensatory strategies.
Commonly abbreviated as SDC. It is one of the electrodiagnostic method used in physiotherapy to detect presence or absence of excitable nerve fibers in a muscle.
The document describes various techniques used in physical therapy for neuromuscular re-education and facilitation including proprioceptive neuromuscular facilitation, neurodevelopmental technique, sensory integration, Brunnstrom movement therapy, and Rood's technique. It provides details on how each technique is applied and the receptors and responses targeted through different stimuli like stretching, traction, touch, and movement.
Dr. James Cyriax developed Cyriax techniques in the early 1900s as a systematic approach to soft tissue injuries. The techniques involve selective tissue tension testing to diagnose lesions, followed by treatments like deep friction massage, passive movements, and active exercises. Deep friction massage uses longitudinal or transverse forces to separate tissue fibers and relieve pain. Passive movements can be graded from low-force range-of-motion to high-velocity small-amplitude thrusts. Active exercises prevent immobilization effects and maintain tissue integrity. Together, Cyriax techniques aim to accurately diagnose and beneficially treat soft tissue disorders.
Hierachical theory- says that higher centers control on lower center; but when higher center damage then this inhibitory control from the higher center is loss which leads to exageration of the movt.
In normal individual, these occur a smooth, rhythmic movt. Because there is a presence of control from higher center on lower center.
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.
Principles and application of various Neurological Approaches. Comprises of PNF, ROODS, NDT, BOBATH, SENSORY INTEGRATION, BRUNNSTORM, VOJTA, Motor Re-learning Approach , Neural Tissue Mobilization
Retraining of motor control basing on understanding of normal movement & analysis of motor dysfunction.
Emphasis of MRP is on practice of specific activities, the training of cognitive control over muscles & movt. Components of activities & conscious elimination of unnecessary muscle activity.
In rehabilitation programme involve – real life activities included.
Rood's approach is a neurophysiological approach developed by Margaret Rood in 1940 that uses controlled sensory input to activate motor patterns. It is based on the premise that motor output depends on sensory input and follows a normal developmental sequence. The goals of Rood's approach include normalizing muscle tone through facilitating light mobilizing muscles and inhibiting heavy stabilizing muscles, treating patients at their functional developmental level, directing movement towards functional goals, and using repetition to form new motor patterns. Sensory techniques like light touch, vibration, and vestibular stimulation are used to facilitate muscles, while techniques like rocking, stroking and maintained stretch inhibit muscles. The approach is applied based on a patient's specific impairments like spasticity or
At the end of the lecture, the students should be able to:
Discuss the theoretical basis of the neurodevelopmental approaches
Discuss the concepts and principles underlying the Bobath approach
Discuss the concepts and principles underlying the Brunnstrom approach
Ap facilitatory and inhibitatory techniqueAnwesh Pradhan
This document discusses several sensory motor approaches used in neurophysiotherapy, including Rood's approach, PNF, neurodevelopmental approach, sensory integration, and Brunnstrom's movement therapy. It provides details on the theoretical basis, principles, techniques, and strategies of each approach. Rood's approach focuses on normalizing muscle tone through sensory stimulation to produce purposeful movement. PNF uses techniques like manual contacts, stretch, and traction to stimulate proprioceptors and facilitate desired movement. The neurodevelopmental approach was developed by Bobath and aims to modify abnormal movement patterns.
The document discusses proprioceptive neuromuscular facilitation (PNF), a technique developed by Herman Kabat that uses movements and patterns to improve neuromuscular function. It defines key PNF terms and outlines principles such as motor development occurring from head to toe. The basic procedures are described, including manual contacts, stretch, and maximal resistance. Upper and lower extremity diagonal patterns are explained along with their component motions. Rhythmic initiation is also summarized.
Vojta technique is a treatment method developed by Dr. Vaclav Vojta based on reflex locomotion and developmental kinesiology. It stimulates specific zones of the body to elicit involuntary motor responses and movement patterns. The zones activate rolling, creeping, and other movements to improve musculoskeletal issues and central nervous system disorders. Vojta therapy is used for various conditions like cerebral palsy, stroke, hip dysplasia, and aims to enhance motor skills, posture, respiration and autonomic function through reflex-based exercises in supine, prone, and side-lying positions.
NDT, BOBATH TECHNIQUE, BASIC IDEA OF BOBATH, CONCEPT OF BOBATH, NEUROPHYSIOLOGY OF NDT, ICF MODEL, PRINCIPLES OF TREATMENT OF NDT IN STROKE AND CP, AUTOMATIC AND EQUILIBRIUM REACTIONS, KEY POINTS OF CONTROL, FACILITATION, INHIBITION AND HANDLING IN NDT
1. Neurodevelopmental therapy (NDT) was developed in 1948 by Berta and Karel Bobath to treat patients with central nervous system damage like hemiplegia and stroke.
2. NDT uses a problem-solving approach involving examination of posture, movement, functional skills, and systems to develop individualized treatment plans. The goal is to minimize impairments and prevent secondary disabilities.
3. The NDT examination process evaluates clients holistically, incorporates their family/environment, and identifies both limitations and competencies to inform treatment planning.
This document discusses the role of physiotherapists in primary health care. It defines what a physiotherapist is and outlines their training. Physiotherapists can provide services across various areas like chronic disease management, falls prevention, and treatment of musculoskeletal issues. Integrating physiotherapists into primary care teams has benefits like increased patient and physician satisfaction, decreased wait times, and reduced costs compared to specialist care. The document provides examples of physiotherapists' roles in assessing and managing issues like diabetes, arthritis, obesity, incontinence and more. It also discusses evidence supporting physiotherapists' integration into primary health care in Ontario.
This document discusses biomechanics and activities of daily living. It defines biomechanics as the study of mechanics in the human body. Functional biomechanics looks at the link between the human body and its environment. Biomechanics consists of kinematics, the description of motion, and kinetics, the forces producing motion. Common activities like running, lifting, and walking are analyzed in terms of joint motion and ground reaction forces. Proper form and muscle engagement can reduce stresses, as seen in squat lifting versus stoop lifting.
The document discusses Margaret Rood's approach to neurorehabilitation, which uses controlled sensory input to facilitate motor control. Rood believed motor functions develop from primitive reflexes through stimulation of appropriate sensory receptors. Her approach uses techniques like light touch, brushing, icing, stretching, resistance, tapping, and vestibular stimulation to activate cutaneous and proprioceptive receptors. While Rood's theory aimed to improve motor function, some aspects are outdated and more research is needed to evaluate the physiological effects of her techniques.
The document discusses recreation planning standards and their shortcomings. While standards-based approaches to recreation provision are commonly used, they ignore important community-specific factors like demographics, needs, climate, and existing facilities. Instead, the document advocates for a social impact assessment approach which involves stakeholder engagement, community consultation, and an analysis of trends, needs, and existing provision to determine appropriate recreation facilities for a given population. It then provides a table benchmarking recreation facility provision across various Australian communities.
The document describes the Motor Re-Learning Program (MRP), an approach to improving motor control after stroke. The MRP focuses on relearning daily activities through task-oriented practice and is based on theories of distributed motor control. The summary is:
1. The MRP involves analyzing tasks, practicing missing components, practicing whole tasks, and transferring learning to other contexts.
2. Intervention follows four steps - analyzing the task, practicing missing components, practicing the whole task, and transferring learning.
3. The program evaluates and improves functions like upper limb use, sitting, and walking through identifying normal movement and compensatory strategies.
Commonly abbreviated as SDC. It is one of the electrodiagnostic method used in physiotherapy to detect presence or absence of excitable nerve fibers in a muscle.
The document describes various techniques used in physical therapy for neuromuscular re-education and facilitation including proprioceptive neuromuscular facilitation, neurodevelopmental technique, sensory integration, Brunnstrom movement therapy, and Rood's technique. It provides details on how each technique is applied and the receptors and responses targeted through different stimuli like stretching, traction, touch, and movement.
Dr. James Cyriax developed Cyriax techniques in the early 1900s as a systematic approach to soft tissue injuries. The techniques involve selective tissue tension testing to diagnose lesions, followed by treatments like deep friction massage, passive movements, and active exercises. Deep friction massage uses longitudinal or transverse forces to separate tissue fibers and relieve pain. Passive movements can be graded from low-force range-of-motion to high-velocity small-amplitude thrusts. Active exercises prevent immobilization effects and maintain tissue integrity. Together, Cyriax techniques aim to accurately diagnose and beneficially treat soft tissue disorders.
Hierachical theory- says that higher centers control on lower center; but when higher center damage then this inhibitory control from the higher center is loss which leads to exageration of the movt.
In normal individual, these occur a smooth, rhythmic movt. Because there is a presence of control from higher center on lower center.
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.
Principles and application of various Neurological Approaches. Comprises of PNF, ROODS, NDT, BOBATH, SENSORY INTEGRATION, BRUNNSTORM, VOJTA, Motor Re-learning Approach , Neural Tissue Mobilization
Retraining of motor control basing on understanding of normal movement & analysis of motor dysfunction.
Emphasis of MRP is on practice of specific activities, the training of cognitive control over muscles & movt. Components of activities & conscious elimination of unnecessary muscle activity.
In rehabilitation programme involve – real life activities included.
Rood's approach is a neurophysiological approach developed by Margaret Rood in 1940 that uses controlled sensory input to activate motor patterns. It is based on the premise that motor output depends on sensory input and follows a normal developmental sequence. The goals of Rood's approach include normalizing muscle tone through facilitating light mobilizing muscles and inhibiting heavy stabilizing muscles, treating patients at their functional developmental level, directing movement towards functional goals, and using repetition to form new motor patterns. Sensory techniques like light touch, vibration, and vestibular stimulation are used to facilitate muscles, while techniques like rocking, stroking and maintained stretch inhibit muscles. The approach is applied based on a patient's specific impairments like spasticity or
At the end of the lecture, the students should be able to:
Discuss the theoretical basis of the neurodevelopmental approaches
Discuss the concepts and principles underlying the Bobath approach
Discuss the concepts and principles underlying the Brunnstrom approach
Ap facilitatory and inhibitatory techniqueAnwesh Pradhan
This document discusses several sensory motor approaches used in neurophysiotherapy, including Rood's approach, PNF, neurodevelopmental approach, sensory integration, and Brunnstrom's movement therapy. It provides details on the theoretical basis, principles, techniques, and strategies of each approach. Rood's approach focuses on normalizing muscle tone through sensory stimulation to produce purposeful movement. PNF uses techniques like manual contacts, stretch, and traction to stimulate proprioceptors and facilitate desired movement. The neurodevelopmental approach was developed by Bobath and aims to modify abnormal movement patterns.
The document discusses proprioceptive neuromuscular facilitation (PNF), a technique developed by Herman Kabat that uses movements and patterns to improve neuromuscular function. It defines key PNF terms and outlines principles such as motor development occurring from head to toe. The basic procedures are described, including manual contacts, stretch, and maximal resistance. Upper and lower extremity diagonal patterns are explained along with their component motions. Rhythmic initiation is also summarized.
Vojta technique is a treatment method developed by Dr. Vaclav Vojta based on reflex locomotion and developmental kinesiology. It stimulates specific zones of the body to elicit involuntary motor responses and movement patterns. The zones activate rolling, creeping, and other movements to improve musculoskeletal issues and central nervous system disorders. Vojta therapy is used for various conditions like cerebral palsy, stroke, hip dysplasia, and aims to enhance motor skills, posture, respiration and autonomic function through reflex-based exercises in supine, prone, and side-lying positions.
NDT, BOBATH TECHNIQUE, BASIC IDEA OF BOBATH, CONCEPT OF BOBATH, NEUROPHYSIOLOGY OF NDT, ICF MODEL, PRINCIPLES OF TREATMENT OF NDT IN STROKE AND CP, AUTOMATIC AND EQUILIBRIUM REACTIONS, KEY POINTS OF CONTROL, FACILITATION, INHIBITION AND HANDLING IN NDT
1. Neurodevelopmental therapy (NDT) was developed in 1948 by Berta and Karel Bobath to treat patients with central nervous system damage like hemiplegia and stroke.
2. NDT uses a problem-solving approach involving examination of posture, movement, functional skills, and systems to develop individualized treatment plans. The goal is to minimize impairments and prevent secondary disabilities.
3. The NDT examination process evaluates clients holistically, incorporates their family/environment, and identifies both limitations and competencies to inform treatment planning.
This document discusses the role of physiotherapists in primary health care. It defines what a physiotherapist is and outlines their training. Physiotherapists can provide services across various areas like chronic disease management, falls prevention, and treatment of musculoskeletal issues. Integrating physiotherapists into primary care teams has benefits like increased patient and physician satisfaction, decreased wait times, and reduced costs compared to specialist care. The document provides examples of physiotherapists' roles in assessing and managing issues like diabetes, arthritis, obesity, incontinence and more. It also discusses evidence supporting physiotherapists' integration into primary health care in Ontario.
This document discusses biomechanics and activities of daily living. It defines biomechanics as the study of mechanics in the human body. Functional biomechanics looks at the link between the human body and its environment. Biomechanics consists of kinematics, the description of motion, and kinetics, the forces producing motion. Common activities like running, lifting, and walking are analyzed in terms of joint motion and ground reaction forces. Proper form and muscle engagement can reduce stresses, as seen in squat lifting versus stoop lifting.
The document discusses Margaret Rood's approach to neurorehabilitation, which uses controlled sensory input to facilitate motor control. Rood believed motor functions develop from primitive reflexes through stimulation of appropriate sensory receptors. Her approach uses techniques like light touch, brushing, icing, stretching, resistance, tapping, and vestibular stimulation to activate cutaneous and proprioceptive receptors. While Rood's theory aimed to improve motor function, some aspects are outdated and more research is needed to evaluate the physiological effects of her techniques.
The document discusses recreation planning standards and their shortcomings. While standards-based approaches to recreation provision are commonly used, they ignore important community-specific factors like demographics, needs, climate, and existing facilities. Instead, the document advocates for a social impact assessment approach which involves stakeholder engagement, community consultation, and an analysis of trends, needs, and existing provision to determine appropriate recreation facilities for a given population. It then provides a table benchmarking recreation facility provision across various Australian communities.
The document provides information to help plan for retirement, including estimating retirement needs and savings goals. It discusses determining factors like life expectancy, retirement age, desired lifestyle, and healthcare costs. It explains the benefits of tax-deferred savings plans for long-term growth due to compound interest and delayed taxes. Tables are provided to calculate a retirement savings goal and estimated annual contribution needed to achieve that goal by a target age.
APSU is hosting the Gov Run on September 26th on its campus at 6pm. General admission tickets are $15 until June 30th, $20 from August 1st to September 25th, and $25 on race day. Children 5 and under get in free, and there is a military discount. APSU does not discriminate based on attributes such as race, religion, disability status, or veteran status.
The document provides instructions for using a cylinder bore gauge to measure the diameter of a cylinder bore. It explains that the gauge has different sized rods that are inserted into the bore to obtain an accurate measurement. The proper technique is also described, including cleaning the bore, lubricating the gauge, and rotating it during measurement to get the maximum and minimum readings.
Hydraulic fracturing (fracking) involves injecting chemically treated water at high pressure to extract natural gas and oil. While fracking provides economic benefits, it requires large amounts of freshwater and risks environmental disruption if wastewater is improperly managed. The process is regulated by states and laws allow companies to keep fracking chemical contents private, raising concerns among environmentalists. Native American opinions on fracking are mixed, as some support economic gains while others believe it violates spiritual obligations. Parts of Europe have banned fracking out of water contamination worries, while others research its risks and benefits. Careful consideration is needed to maximize fracking's upsides and minimize downsides.
Os ministros da Fazenda, Nelson Barbosa, e do Planejamento, Orçamento e Gestão, Valdir Simão, detalharam hoje a programação orçamentária e financeira do Poder Executivo para o exercício de 2016. Além disso, foram apresentadas medidas de readequação fiscal para o ano de 2016 e propostas de uma reforma fiscal de longo prazo.
The document summarizes a workshop for new faculty on demonstrating the quality and significance of teaching effectiveness. It discusses key areas of faculty performance like teaching, research, and service. It focuses on teaching and provides strategies and examples for effective teaching, scholarly teaching, and the scholarship of teaching and learning. Guidelines for assessing teaching effectiveness include pedagogical skills, professionalism, student learning assessment, professional development, and reflective practice.
1) VAR e VECM são modelos utilizados para analisar séries temporais econômicas inter-relacionadas, capturando suas interdependências e relações de curto e longo prazo.
2) VAR considera todas as variáveis como endógenas e igualmente influentes, enquanto VECM captura relações de longo prazo quando as variáveis são cointegradas.
3) A escolha entre VAR e VECM depende de testes de raiz unitária e cointegração para verificar a estacionariedade das séries e presença de uma
Constraint-induced movement therapy (CIMT) involves restricting use of an unaffected limb while intensively training an affected limb for several hours per day. It is based on research showing that restricting use of a monkey's unaffected forelimb led to improved use of the affected limb. Studies in humans found that restricting an unaffected arm along with task-specific training of the affected arm improved function of that arm. The EXCITE trial, a large randomized controlled trial, provided strong evidence of CIMT's efficacy for improving arm function after stroke. While very effective, the intensive nature of CIMT presents challenges to implementation in clinical settings. Modified versions have aimed to address these issues.
Neuroplasticity, also known as brain plasticity, is an umbrella term that describes lasting change to the brain throughout an animal's life course. The term gained prominence in the latter half of the 20th century, when new research showed many aspects of the brain remain changeable (or "plastic") even into adulthood.
Tecnologías que mejoran el resultado en el proceso de rehabilitación de perso...Teletón Paraguay
The document discusses technology for children with cerebral palsy and other disabilities. It summarizes several technologies including:
1) Robotic gait technology like Lokomat that can enhance activities like walking through increased practice.
2) Ultrasound technology that can more accurately quantify impairments in body structures and functions like muscle stiffness.
3) Substitution technologies like powered wheelchairs and brain-computer interfaces that can enable participation through alternative means of mobility.
Effectiveness of cpm and conventional physical therapy after total knee arthr...FUAD HAZIME
This randomized clinical trial compared the effectiveness of 3 in-hospital rehabilitation programs following primary total knee arthroplasty (TKA): 1) conventional physical therapy alone, 2) conventional physical therapy with 35 minutes of continuous passive motion (CPM) daily, and 3) conventional physical therapy with 2 hours of CPM daily. Outcome measures included range of motion, functional ability, and length of stay. The results showed no significant differences between the groups for any outcomes, suggesting that adding CPM to conventional physical therapy provided no additional benefits after primary TKA.
Presented an in-service on the evidence behind and the application of thoracic spine manipulation to the Martinsburg VA Medical Center's rehabilitation staff including: 7 PTs, 8 PTAs, 3 OTs, and 4 students.
1) This study examined fear of falling and functional ability in older adults undergoing hip surgery in Thailand.
2) A total of 33 older adult participants undergoing hip surgery were included in the study.
3) Baseline characteristics of participants showed that most were female, widowed, with comorbidities like hypertension and diabetes. The main cause of hip fracture was falls during daily activities.
manipulations for the cervical and lumbar spineamj20008
The document summarizes research on spinal manipulation for low back pain. It finds that manipulation is more effective than sham therapy or therapies deemed ineffective/harmful for acute low back pain. However, manipulation provides no significant advantage over other treatments like general practitioner care, analgesics, physical therapy, exercises, or back school. The document also outlines potential side effects of manipulation and clinical prediction rules to determine which patients are most likely to benefit from manipulation.
1) The document summarizes a study on evaluating quality of life (QOL) in patients before and after total hip arthroplasty (THA) surgery in Vietnam.
2) It finds that patients reported significantly higher QOL scores after surgery compared to before, though physical functioning was somewhat reduced in the initial postoperative period.
3) Key factors impacting QOL changes included issues with overload of patients, lack of treatment/care, and insufficient information provided to patients about rehabilitation and managing postoperative complications.
Learn about chiropractic and how to choose a proper and qualified chiropractor quickly.
Visit http://www.chiropractorhunter.com for finding chiropractors near you!
The document discusses shoulder pain, specifically subacromial pain/non-specific shoulder pain. It notes that shoulder pain is prevalent, can impact daily activities, and for 40% of patients the pain is ongoing or recurrent after 12 months. Imaging and physical exams are not always reliable in diagnosing the source of pain. Exercise appears to be the most promising intervention for shoulder pain, though what type or amount of exercise is unclear. A proposed intervention focuses on teaching patients self-management skills and a home exercise program with 1-5 sessions from a physiotherapist and proactive follow-up.
The document introduces recent advances in rehabilitation technology and provides an overview of 11 devices. It discusses how these technologies can provide real-time feedback, objective measures of progress, and engaging rehabilitation. The technologies discussed include the Balancemaster and Biodex Balance System for balance training, Neuromove and Lokomat for gait rehabilitation, and Armeo for arm rehabilitation. Evidence is presented showing that these technologies have been effective for conditions like stroke and concussions when used as part of a comprehensive rehabilitation program.
This document discusses strategies to prevent and manage delirium in critically ill patients. It outlines the ABCDEF bundle which includes assessing, preventing, and managing pain, both spontaneous awakening and breathing trials, minimizing sedation, assessing and preventing delirium, early mobility and exercise, and engaging family members. Screening for delirium using the CAM-ICU tool and implementing non-pharmacological interventions can reduce length of hospital stay, duration of mechanical ventilation, and mortality. Widespread use of protocols and bundles that incorporate these strategies may help address the high cost and poor outcomes associated with delirium.
Steve Iliffe: Encouraging innovative approaches and policies to improve prima...The King's Fund
Steve Iliffe, Professor of Primary Care for Older People at University College London, spoke at our conference Making health and care services fit for an ageing population. Steve championed an innovative approach to primary care and explains what we need to do to achieve this.
Holistic concept in treatment of Cerebral Palsy jitendra jain
it is very difficult to manage cerebral palsy because we cant repair brain damage but we can give good quality of independent life by combination good rehabilitation tool which include advance therapeutic technique, botulinum toxin early age child and SEMLOSSS surgical concept in others. Our aim of management is to take these person to their highest capability and decrease their physical limitation as much as possible. This ppt have brief review about latest concept in mx of cerebral aplsy
The document describes a study that explored using iPads and computer-based technology to promote health and wellness for adults with intellectual disabilities. Sixteen participants received weekly behavioral weight loss sessions and accessed internet weight loss resources via iPads over 16 weeks. Overall, participants lost a total of 73.8 pounds, averaging a 4.6 pound reduction per person. Men lost an average of 5.6 pounds each while women lost an average of 3.61 pounds each. The study aims to replicate these procedures with a control group and statistical analysis to measure significant differences in outcomes from the intervention.
Low Back Pain & Sciatica, a brief epidemiological introduction and review of 2 articles with conflicting findings addressing the prognostic factors and outcome.
Tecnología para niños con parálisis cerebral y otras discapacidades - Dra. De...Teletón Paraguay
This document discusses technology for children with cerebral palsy and other disabilities. It begins by providing historical context of the Rehabilitation Institute of Chicago and outlines the objectives of quantifying impairments, increasing practice through therapy, and discussing substitution technologies. Ultrasound is discussed as a way to quantify muscle properties and stiffness. Robotic gait training using Lokomat is presented as a method to increase practice intensity and improve activities like walking. Challenges and opportunities for data collection across centers to improve guidelines for robotic device use are also covered.
Current Techniques For Rehabilitation Of Upper Limb After Stroke Ademola Adeyemo
This document outlines current techniques for rehabilitation of the upper limb after stroke. It discusses the effects of stroke on the upper limb such as weakness, spasticity and loss of sensation. Factors to consider in management include handling the hemiplegic limb, positioning, and addressing low or increased tone. Techniques covered include bilateral arm training, mirror therapy, mental imagery, constraint-induced movement therapy, robotic devices, functional electrical stimulation, strength training and stretching programs. The conclusion advocates for effective use of these techniques to improve functional recovery of the upper limb after stroke.
Presented at the American Association of Neurosurgery 2011 annual meeting by Prof. Dr. Yunus AYDIN:
Preservation of segmental motion with anterior contralateral cervical microdiskectomy and interbody fat, a prospective study
This study analyzed the effectiveness of the Kinetrac KNX-7000 multifunctional bed in treating degenerative diseases of the lumbar spine. 24 patients were divided into two groups - one receiving conventional physiotherapy treatment and the other receiving conventional treatment plus the multifunctional bed. Results showed that the group using the bed had statistically significant improvements in functional abilities, quality of life, and lumbar spine flexion compared to the conventional treatment group. However, there was no statistically significant difference in pain perception between the groups. The study had limitations due to its small sample size.
2. Constraint Induced Movement Therapy
Putting evidence into practice
Nikki Owen (CIMT Therapist)
Blaithin Hadjisophocleous (CIMT Therapist)
3. Objectives
• Understand the background theory to CIMT and how evidence base was developed
• Learn about the protocols for adults and how they were adapted for children
• Overview of evidence base for treatment and its limitations
• Understand our treatment criteria and protocols
• Case studies
4. Development of a theoretical approach
Edward Taub’s work with monkeys between the 1960’s and 1980’s
• Deafferentation of sensory nerves in forelimb results in decreased
functional use and increased reliance on unaffected limb
• Initial motor depression following insult results in negative experiences of
using the limb but positive experience of unaffected limb.
• Leads to learned non-use of affected limb, even after motor control
restored
• Theory of “learned non-use” developed
• (Taub, 1963, 1976, 1980,)
5.
6. Reversing learned non-use
• Restricting use of unaffected limb for 24 hours resulted in improved use of
affected limb.
• However reverted back to original pattern of use once restriction removed
• Restriction of use for longer period – eg 1 week of 24 hour continuous
restriction – resulted in carry-over once restriction removed. Limb use was
clumsy but functional.
• With addition of specific task training, quality of limb activity improved
(not to “normal” but to “very good”)
• (Taub, 1976, 1980)
7. Transfer to humans
• Initial studies looked only at the constraint element (“Forced Use”)
• Results were promising but treatment effect small (Ostendorf et al,
1981)
• Taub’s team implemented the full protocol: constraint of unaffected
side and intensive training of affected side
• They took patients > 4 years post stroke and split into groups
• Experimental group wore mitt 90% waking hours, 6 hours training per
day for 14 days. Control group given passive movement programme
• Experimental group showed significant increases in all objective
measures and in real-world arm use at two weeks, and at a two year
follow up. No change in control group (Taub et al, 1993)
8. Transfer to humans
• Other sites carried out similar research, all achieving positive results.
• A large effect size for transfer of treatment outcome to daily activities
is considered to be 0.8.
• Most studies of CI Therapy were producing effect sizes of between 2.1
to 4.0 (Taub, 2002)
EXCITE RCT (Wolf et al, 2006)
Single-blind, randomised multisite trial.
7 sites, 222 patients, 12 month follow-up.
2 week CIMT Programme –v- customary care
CIMT produced statistically significant and clinically relevant
improvements in arm motor function that persisted for at least 1 year.
9. CI Protocol for adults
The key elements for CIMT in adults :
• Restraining the less affected arm
• Shaping behaviour in the training tasks
• Assuring the patient could understand and conduct the
training
• Treatment provided by well trained therapists who could
motivate patients to participate
• A transfer package to ensure achievements are carried out of
the clinic and into real life
10. Why CIMT works - Cortical Reorganisation
The representation of your body is continually reorganised on the cortex
Representation is “use dependent”
• Braille readers (Sterr et al, 1998)
• Violin players (Elbert et al, 1995)
• Stroke patients (Liepert et al, 1998)
Representation can be altered quickly, but may not last.
• Web four fingers together – “smudging” noted after 30 minutes.
• Can last for 2 hours if webbed for 5 hours (Stavrinou et al, 2007)
11. Use-Dependent Cortical Reorganisation
CIMT has repeatedly been associated with use-dependent increase in
cortical organisation.
• Liepert et al (1998, 2000) showed increases in cortical regions of the
affected hand after CIMT.
• The cortical changes remained on 6 month follow up.
12. CIMT - expanding applications
• TBI
• Hemispherectomy (up to
10 years post surgery)
• Congenital hemiparesis
in adults
• Focal hand dystonia
• Nerve surgery
• Parkinson’s Disease
• MS
• Spinal cord injury
• Lower limb
• Speech
13. CIMT for Children
Taub’s team realised that the principles of CI Therapy for adults could
easily be applied to children
14. “Learned non-use” / “Development Disregard”
• For children who suffer CNS injury in prenatal, perinatal or early
postnatal the theoretical situation differs to that of an adult with a
sudden CNS lesion.
• The underlying neural framework for movement with complex cortical
pathways has not developed.
• The lack of movement and appropriate sensory input during early
development can be devastating.
• The differences between the two sides of the body become greater
and more noticeable with increasing age and functional use.
15.
16. CIMT for Children
Taub et al (2004) applied CI Protocols to children for first time
• RCT of 18 children with CP (7 – 96 months old)
• CIMT vs conventional therapy
• Casting unaffected arm and intensive training of affected side for 6 hours
per day over 21 consecutive days
• CIMT group acquired significant improvements in:
• motor skills
• amount and quality of more-affected arm use at home
• Benefits were maintained over 6 months, with supplemental evidence of
quality-of-life changes for many children.
17. CIMT for Children
• Deluca et al (2005) conducted a cross-over trial
with the same group of children.
• Graph shows QUEST results at pre, post and 3
week follow up.
Evidence base for paediatrics continues to build.
• Sakzewski et al (2009) – Systematic review
summarised that “CIMT resulted in a large
treatment effect for the development of new UL
motor skills and an increased amount of use of the
impaired limb.”
• Sterling et al (2013) – replicated findings in
changes to grey matter in children
18. Critique of Evidence
Sakzewski et al, 2009
• Inconsistencies in outcome measure & the intensity of intervention for control groups
• Not all studies follow the same protocols.
19. CIMT – Developing our protocols
• Multisite RCT with 6 month follow up (Case-Smith et al, 2012)
• Compared 6 hours therapy per day with 3 hours per day (cast worn 24
hours)
• Found no significant difference in improvements between groups
20. Our criteria and protocols - Adult
Criteria
• > 6 months post-stroke
• At least 10 degrees active wrist and finger extension (from any start
position)
• Cognitive ability to engage in treatment programme
Protocol
• Constraint mitt worn 90% waking hours
• 3 hours therapy a day, 5 days a week
• 2 or 3 week programme
21. Our criteria and protocols - Children
Criteria
• > 18 months old
• Ability to tolerate treatment programme
• Enough activity to positively participate in play
• Parents / carers who are able to actively participate in programme and
post-treatment
Protocol
• Non-removable cast worn for duration (changed weekly)
• 3 hours therapy a day, 5 days a week – play based
• 3 or 4 week programme
22. Boundaries of CIMT
CIMT has a robust evidence base that shows it can make significant improvements to real-world use of an
affected upper limb. However:
• CIMT does not make movement “normal”
• CIMT cannot restore motor function to match unaffected side
• Effect of CIMT is determined by severity of the initial impairment
• Taub (2007) – Retention rates tend to be 70% at 6 months follow up.
• “One of the important factors contributing to good retention was the compliance of recommended post-
treatment regimen.”
• He suggested “top-up” CIMT may be of benefit in future years for those children.
• Highlights importance of follow up therapy input after CIMT programmes
23. Case Studies
Pre-Treatment Post-Treatment Difference
Dissociated Movements (%) 65 75 10
Grasps (%) 44 55 11
Weight Bearing (%) 72 84 12
Overall Score (%) 60 71 11
Archie
QUEST – Quality of Upper Extremity Skills Test
Note – an increase of 4.89% or more is considered statistically significant.
25. References
Case-Smith, J., DeLuca, S., 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, 15–23
Deluca, S. C., Echols, K., Law, C. R., Ramey, S. L. (2006) Intensive Pediatric Constraint-Induced Therapy for Children
With Cerebral Palsy: Randomized, Controlled, Crossover Trial. Journal of Child Neurology 21:931–938
Elbert T, Pantev C, Wienbruch C, Rockstroh B, Taub E. (1995) Increased use of the left hand in string players
associated with increased cortical representation of the fingers. Science 1995; 220:21-23.
Liepert J, Bauder H, Sommer M, Miltner WHR, Dettmers C, Taub E, Weiller C (1998). Motor cortex plasticity during
Constraint-Induced Movement therapy in chronic stroke patients. Neuroscience Letters 1998; 250:5-8
Liepert J, Bauder H, Miltner WHR, Taub E, Weiller C. (2000) Treatment-induced cortical reorganization after stroke in
humans. Stroke; 31:1210-1216
Ostendorf CG, Wolf SL. (1981) Effect of forced use of the upper extremity of a hemiplegic patient on changes in
function. Phys Therapy 61:1022-1028.
26. References
Sakzewski, L., Ziviani, J., Boyd, R., (2009) Systematic Review and Meta-analysis of Therapeutic Management of
Upper-Limb Dysfunction in Children with Congenital Hemiplegia. Pediatrics ;123;e1111-e1122;
Stavrinou, M.L, Penna, S. D., Pizzella, V., Torquati, K., Cianflone, F., Franciotti, R., Bezerianos, A., Romani, G. L.,
Rossini, P. M. (2007) Temporal Dynamics of Plastic Changes in Human Primary Somatosensory Cortex after Finger
Webbing. Cerebral Cortex 17(9) 2134-2142
Sterling, C., Taub, E., Davis, D., Rickards, T., Gauthier, L.V., Griffin, A., Uswatte, G. (2013) Structural Neuroplastic
Change After Constraint-Induced Movement Therapy in Children With Cerebral Palsy. PEDIATRICS Vol. 131 No. 5
Sterr A, Müller MM, Elbert T, Rockstroh B, Pantev C, Taub E. (1998) Changed perceptions in Braille readers. Nature
391:134-135
Taub E, Berman AJ. (1963) Avoidance conditioning in the absence of relevant proprioceptive and exteroceptive
feedback. J Comp Physiol Psychol; 56:1012-1016
Taub E. (1976) Motor behavior following deafferentation in the developing and motorically mature monkey. In:
Herman R, Grillner S, Ralston HJ, Stein PSG, Stuart, D, eds., Neural Control of Locomotion. New York: Plenum, 675-
705
27. References
Taub E. (1980) Somatosensory deafferentation research with monkeys: implications for rehabilitation medicine. In:
Ince LP, ed., Behavioral Psychology in Rehabilitation Medicine: Clinical Applications. New York: Williams & Wilkins,
371-401
Taub E, Miller NE, Novack TA, Cook EW III, Fleming WC, Nepomuceno CS, Connell JS, Crago JE. (1993) Technique to
improve chronic motor deficit after stroke. Arch Phys Med Rehabil; 74:347-354
Taub E, Uswatte G, Elbert T. (2002) New treatments in neurorehabilitation founded on basic research. Nature
Reviews Neuroscience 3:228-236
Taub, E., Griffin, A., Nicka, J., Gammonsa, K., Uswattea, G., Law, C. R. (2007) Pediatric CI therapy for stroke-induced
hemiparesis in young children. Developmental Neurorehabilitation, 10 (1)
Taub E, Ramey S L, DeLuca S, Echols K. (2004) Efficacy of Constraint-Induced (CI) Movement therapy for children with
cerebral palsy with asymmetric motor impairment. Pediatrics ;113: 305-312
Wolf, S., Winstein, C., Miller, P. J., Taub, E., Uswatte, G., Morris, D., Giuliani, C., Light, K. E., Nichols-Larsen, D. (2006)
Effect of Constraint-Induced MovementTherapy on Upper Extremity Function 3 to 9 Months After Stroke. The EXCITE
Randomized Clinical Trial. Journal of the American Medical Association, November 1, Vol 296, No. 17
Editor's Notes
Behavioural adaptation as opposed to purely physical
Taub is behavioural neuroscientist
24,25,35-37
2 Pathways wont develop normally for that limb and when used abnormally in function for example crawling – will then develop abnormally for that limb
3 - Don’t use it you will loose it/ never gain it! Gets worse with age
Start on Yellow explain this is how the pathways are laid down. First is newborn then more meaningful.
Normal = Blue skill accusision, positive reinforcement of achieving activity leading to sensory feedback, social rewards etc. Will keep trying and improving
Affected = Red negative cycle, don’t achieve task, don’t complete task, poor feedback (due to sensory/tone)
More RCT’s needed but as we know this is difficult in paediatric population.
We wanted to use best evidence to form our programme.
Taubs clinic’s in America started with 6 hours and research was based around this however …….
This lead to us deciding 3 hours was enough. And from experience it would take a very focused (age appropriate individual to achieve 6 hours good therapy)
We will engage with leading therapy teams, you can attend sessions, report at end summarising changes etc