CIMT
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How does CIMT work?
Treatment Process
The specific approach of CIMT involves a 2 week training period that requires 6 hours of daily repetitive, graded, task-specific training of the paretic arm while restraining the unaffected limb. Constraint of the less affected UE occurs for 90% of waking hours throughout the entire fortnight.
CIMT has also led to the development of modified constraint-induced movement therapy (mCIMT), which is a less intensive form of CIMT. As the name implies, mCIMT is a modified version of CIMT and it differs because the training period duration is for 2 to 3 weeks and includes less than 6 hours per day of limited constraint of the more affected UE. Some studies claim that a comparison study of these two protocols has not shown significance differences in terms of positive outcomes for the patients (McIntyre et al., 2012).
Components
1. Repetitive, task-oriented training
a. Shaping (a.k.a Adapted Task Practice): involves continuous feedback to invoke positive reinforcements in the use of the affected arm as individuals succeed in performing a functional task. Tasks are then successively modified in increasing difficulty based on movement goals, potential for improvements, and patient's preference. The focus is on cortical stimulation and overcoming learned non-use.
b. Task Practice: requires an individual to perform a functional based task that is contextually appropriate for real-world situations for 15-30 minutes consecutively.
2. Behavioural strategies
a. Strategies to ensure that individuals comply with the treatment protocol includes engaging in a behavioral contract in which they agree to adhere to the protocol.
b. Complete and practice home skill assignments as well as recording activities in a diary
c. Record the frequency of the use of the affected arm in real-world environments
3. Constraint of less affected UE
a. Restraint the less affected UE while encouraging the use of the affected arm.
(Henderson & Martens, n.d.)