STROKE-CONSTRAINT INDUCED MOVEMENT THERAPY (CIMT)
SUMMARY
1. CIMT has been shown to produce significant improvements in arm motor function that persist > 1 year (EXCITE Trial, Wolf et al., 2006).
2. CIMT requires that patients be able to extend their wrists, actively move their digits & follow instructions.
3. In the EXCITE trial, participants were required to have at least 20o of active wrist extension, at least 10o of thumb abduction/extension, and at least 10o of extension in at least two additional digits, with minimal sensory or cognitive deficits:
- Traditional CIMT: 2 week training program with 6 hours of intensive training with restraint of the normal side for at least 90% of waking hours
- Modified CIMT: variable intensity, time of constraint and duration of program, stronger evidence of benefit than traditional therapy
4. Flannel test for suitability for CIMT: ask the patient to pick up and drop a piece of cloth!
TIMING OF THERAPY
5. Traditional CIMT in the acute/subacute phase may be beneficial for improving spasticty and muscle strength, but not motor function. The literature is mixed regarding improvement on ADLs and dexterity.
6. Modified CIMT in the acute/subacute phase is beneficial for improving motor function, not be beneficial imporving ADLs, dexterity, spasticity, proprioception or muscle strength.
7. Traditional & modified CIMT may be beneficial for imporving motor function, ADLs and muscle strength in the chronic phase following stroke.
Reference(s)
Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].
