CONSTRAINT INDUCED MOVEMENT THERAPY

Transcription

1 CONSTRAINT INDUCED MOVEMENT THERAPY

2 INTRODUCTION Healing is a matter of time, but sometimes it is also a matter of opportunity. Hippocrates. Healing in Neurological conditions is a ongoing process and usually consumes long treatment durations. Many treatment approaches are introduced in Neurological Rehabilitation. One among them and the most popular treatment approach commonly practiced in Neurological Rehabilitation is Constraint Induced Movement Therapy (CIMT).

3 CONSTRAINT INDUCED MOVEMENT THERAPY- CIMT CIMT is a type of treatment of clients with motor system limitations that combined constraint or immobilization of the unaffected arm (sound) with forced use of the affected limb. A hand mitt or sling is used to constrain the use of unaffected upper limb while the affected limb is engaged in forced use The treatment focus on shaping the behavior to improve functional use of impaired limb. CIMT is based on the theory that impairment in hand and arm function in clients after a stroke is compounded by learned nonuse of affected upper extremity,which leads to physical change in the cortical representation of upper limb.

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5 ORIGIN OF CIMT The principles of this method originated from theories in behavioral psychology, motor learning, and skills acquisition. Early research was done by Dr. Edward Taub on surgically deafferented monkeys. Early primate studies demonstrated that if the upper limb was surgically impaired by dorsal rhizotomy to disrupt afferent input to the sensory cortex, the animal stopped using the limb for function. Later, the active mobility was restored by immobilizing the intact upper limb for several days while training the animal to use the affected limb.

6 TYPES OF RESTRAINTS USED The restraints commonly used for CIMT includes, sling triangular bandage splint sling combined with a resting hand splint, half glove Mitt

7 TYPES OF RESTRAINTS USED sling Mitt Splint

8 Treatment Models of CIMT: The treatment models are commonly explained in two methods the Unmodified and Modified CIMT. Unmodified CIMT: Unmodified is a treatment model that uses a variety of motor control approaches to promote the affected limb for 90% of the individuals waking hours. Only activities involving toileting, hygiene (at least weight bear) and bathing or an activity which would be dangerous if the other limb was not used are permitted

9 Modified CIMT: Treatment Models of CIMT Modified CIMT, a more pragmatic model The client is expected to use his/her affected extremity for a minimum of the five top arm use hours at home during each week day

10 Neurophysiologic basis for CMT: The neurophysiologic mechanisms that are believed to underline treatment benefits of CIMT include overcoming learned nonuse and plastic brain reorganization. The effect of CIMT is explained as Cortical Reorganization Dendrite branching Redundancy Synaptic strength.

11 Treatment components: The three important components of CIMT is 1. Repetition, structure, intense practice of the affected arm. 2. Restraint of the less-affected arm (Sound), 3. Monitored arm use in life situations and problem solving to overcome barriers

12 Requirements for participation The individual needs to have a basic grasp/release to be eligible for the program Simply, follow 10 x 10 x 10 eligibility criteria in selecting a patient for CIMT. 10 degrees active wrist extension 10 degrees active thumb abduction 10 degrees active extension of any other two digits on affected hand

13 Treatment Protocol- Unmodified CIMT Direct intervention for 6-8 hours per day continuing for 5 days in a week. the programme is scheduled for 2-3 weeks. During week end the duration allotted should be 3-4 hours. The specific task in Home programme along with Activities of daily living is practiced.

14 Treatment Protocol- Modified CIMT Exercise activities would be done with the restraint on. On weekends, patient should wear the belt and prevented from any kind of specific exercises. Training programme will be performed 6 hours per day, Monday through Friday, for 2 weeks. Varied shaping, task practice, and exercises are designed on the basis of individual resources and problems; patientspecific tasks were chosen and practiced. Short rest periods are included regularly during the training hours, and after lunch patients can take a half-hour rest. If the patient did not complete the 6 hours of training during the rehabilitation day, he or she can practice the same at home

15 Advantages & Disadvantages to CIMT S.No Advantages Disadvantages 1 Overall greater improvements in function vs. conventional treatment 2 Highly researched and credible treatment approach Requires enormous labor from both patient & medical staff Patient endures many hours of frustration 3 Increases daily/social participation 4 Decrease in medical cost over lifetime Patients can suffer from muscle soreness resulting in Stiffness and discomfort in the involved upper extremity as well as skin lesions and skin burns Typically for patients with higher level of function

16 Application of CIMT for patients with stroke: CIMT treatment discourages the use of the unaffected extremity and encourages active use of the hemiplegic arm. The goal is to maximize or restore motor function. CMT is based on the theory that impairment in hand and arm function in clients after a stroke is compounded by learned nonuse of affected upper extremity,which leads to physical change in the cortical representation of upper limb.

17 Constraint Induced Movement Therapy for children The research evidences documented explains that children with hemiplegia or brain injury receiving CIMT for 21 consecutive days, 6 hours a day, demonstrated significant improvement in the amount of use, quality of movement and spontaneous use of affected Upper extremity. It is recommended that the therapists engage in shared decision making and educate parents. Proper guidelines should be informed to the parents prior the treatment sessions.

18 CIMT for child- Left upper limb is constrained

19 Parent Education and Home Program The success of the therapy depends on the efficient continuity of the training programme. updated weekly to guide caregivers' daily structured practice with the children. Concentrate on specific functional activities of interest to the family and child. It is ideal to focuses on one specific skill each week Provide them the form of an activity log to encourage daily follow up throughout the program

20 Conclusion Several lines of reasoning, support early implementation of CIM. From a motor learning perspective, early implementation might minimize learned nonuse The ultimate goal of treatment is to maximize social participation and quality of life

21 REFERENCES: Taub, E. et al. Constraint-induced movement therapy: a new family of techniques with broad application to physical rehabilitation a clinical review. Journal of Rehabilitation Res Dev. 1999; 36: Taub, E. et al. Constraint induced manual therapy and massed practice. Stroke. 2000; 31: Richards, L. et al. Limited dose response to Constraint-Induced Movement Therapy in patients with chronic stroke. Clinical Rehabilitation 2006; 20: Sterr, A. et al. Longer versus shorter daily constraint-induced movement therapy of chronic hemiparesis: and exploratory study. Archives of Physical Medicine & Rehabilitation. 2002; 83: Evidence-based care guideline for pediatric constraint induced movement therapy (CIMT). Cincinnati (OH): Cincinnati Children's Hospital Medical Center; 2009 Feb p Neurological Rehabilitation, Darcy A umphred, RonaldoT. Lararo.et al,6 th edition. Constraint Induced Movement Therapy for Rehabilitation Donald Earley, OTD, MA,OTR