Constraint-Induced Movement Therapy (CIMT)

The term Constraint-Induced Movement Therapy (CIMT) describes a package of interventions

designed to decrease the impact of a stroke on the upper-limb (UL) function of some stroke
survivors. It is a behavioural approach to neurorehabilitation based on "Learned- Nonuse".

● Constraint-induced movement therapy (CI therapy) involves a variety of components that

are thought to promote increased use of the more-impaired UE both in the research
laboratory/clinic or home setting.

● The main novel feature of CI therapy is the combination of these treatment components and
their application in a prescribed, integrated and systematic manner to induce a patient to
use a more-impaired UE for many hours a day for a period of 2 or 3 consecutive weeks
(depending on the severity of the initial deficit).

History
Constraint-Induced Movement Therapy was developed by Dr. Edward Taub, who demonstrated that
monkeys with a surgical de-afferentation (i.e. somatic sensation was abolished) of a forelimb, ceased
using the affected extremity. Through failed attempts to use the de-afferented forelimb, the
monkeys developed compensation methods to avoid using the affected limb, that is, they effectively
learned not to use their affected extremity, he hypothesed that this non use was a learning
mechanism and called this behaviour as learned non use. Then, after immobilizing the intact arm for
a period of consecutive days, the monkeys started to use the de afferented forelimb again and the
learned non use was overcome.

Population for CIMT

● Stroke

● Traumatic Brain Injury

● Multiple Sclerosis

● Cerebral Palsy

● Spinal Cord Injury

● Brachial Plexus Injury

Mechanism of CIMT
The known mechanisms of CIMT in the poststroke reconstruction of neurological function mainly
include an increase in the number of synapses, an increase in dendritic arborization in the motor
cortex, and changes in neurotrophic factors.

Hu et al. (2019) used diffusion tensor imaging to quantify the fractional anisotropy and mean
diffusion coefficient of the CST before and after CIMT in stroke rats and found that CIMT promoted
functional recovery after an ischemic stroke by promoting the reconstruction of the ipsilateral CST.
Using micro-positron emission tomography/computed tomography imaging, Li et al. found that CIMT
improved the behavioral results of cerebral ischemic rats, an improvement that may be related to an
increase in glucose utilization in the contralateral cerebral hemisphere.

Restraining tools
● Sling

● Splint

● Plaster cast

● Mitt

● Triangular bandage

● Half glove

Components of CIMT
Repetitive, task-oriented training

 Shaping
 Task practice

Adherence-enhancing behavioural strategies (i.e.,) transfer package

 Daily administration of motor activity log

 Home diary
 Problem solving to overcome apparent barriers to use of more affected upper extremity in
the real world situation
 Behavioural contract
 Caregiver contract
 Home skill assignment
 Home practice
 Daily schedule

Constraining use of the more affected UE

 Mitt restraint
 Any method to continually remind the participant to use the more affected UE

Indication for use of CIMT

Participants who have suffered a stroke require some hand function, high motivation, minimal
cognitive dysfunction, adequate balance and adequate walking ability while wearing the restraint to
be eligible to participate in CIMT interventions.

● The minimum motor criterion for inclusion into therapy is:

● 10° wrist extension

● 10° thumb abduction

● 10° finger extension

Learned non use

Reversing learned non use

Advantages of CIMT

● Great improvement in function than traditional treatment.

● Highly researched and highly credible treatment approach.

● There are brain activity and observed gray matter reorganization in primary motor, cortices
and hippocampus.

● Increase social participation.

● Decrease in medical cost over lifetime.

Disadvantages of CIMT

● Studies have showed burns, minor skin lesions and muscle soreness (stiffness and
discomfort) in the affected upper extremity