1
CIMT is an intense task-oriented practice of more affected UE for up to ____ hours a day?
6 hours/day
- Large prospective, single blind, randomized, multisite study that included 222 patients after stroke
- Inclusion criteria
- Potential for recovery
- Some residual UE and hand movement (active wrist and finger extension) but tended not to use the arm
- Limited pain
- Limited spasticity
- Absence of cognitive impairment
EXCITE study for CIMT
- Promote increased use of affected UE
- Therapist uses shaping techniques to modify and progress performance
- Feedback, coaching, modeling and encouragement provided during practice
- Behavioral methods designed to ensure adherence to exercise and developing task-oriented behaviors
CIMT
What were the main active motions that the patient had to be able to perform in order to be considered for the EXCITE study?
Active wrist and finger extension
Less affected UE restrained from use up to ____% of waking hours?
90%
- Compared to customary care CIMT significantly improves outcomes
- Associated changes in brain organization on functional MRI
- Significant functional gains
- Hundreds of studies - most with positive results
- Early studies - patients with chronic stroke > 1 year
CIMT in patients s/p CVA
T/F: With CIMT, all activities will take 2-3x longer than it would with unaffected arm?
True
Can start when the patient is stable and the stroke is no longer evolving **
If this is done immediately after stroke, there is a chance of increase of brain bleed and swelling
What is the dosage/frequency of CIMT in young children?
2 hours per day, 3x/week ***
- Daily administration of the motor activity log
- home diary
- Problem solving to overcome apparent barriers to use of the more affected UE in the real world situation
- Behavioral contract
- caregiver contract
- written home skill assignment with check off list
- home practice
- daily schedule
- phone calls and text messages
Adherence-enhancing behavioral strategies
- Age appropriate activities that sustain interest for long periods
- Duration and type of restraint must be modified
- Studies range from 6 months to 18 years
- Nearly all studies reported positive outcomes
- diversity of approaches
- no evidence suggests that one type of restraint is more effective than another
- repeated doses of CIMT have been shown to have an additive effect
- can be considered as part of a childs long term therapy
CIMT in children with hemiparesis
- Both part and whole practice methods
- Modifying tasks to ensure success and progression of difficulty as success is achieved
- Active problem solving
- Optimal practice and feedback schedules
- Need to generalize learning to performance in everyday environments
- children must overcome developmental disuse - may need to learn how to use UE for the first time
- developmentally focused (motor milestones)
CIMT and motor learning principles
What are the (4) techniques of constrain therapy in children?
1. Cast
2. Splint
3. Ace wraps
4. Protective Mitt
- Potentially psychologically and physically invasive
- Use of less affected side still developing
- Restriction of limb use early reduces topographic distribution
- Risk of damage to the less affected UE if restrained for long periods at too early an age
- Modified protocol is required in young children
- Focuses on unimanual impairments, which do not greatly influence functional independence and QOL
- training likely improves manual dexterity- lacks specifically for how hand will be used- as nondominant assisting hand during bimanual activities
- Children with hemiplegia have impairments in spatial and temporal coordination of the two hands, as well as global impairments in motor planning- CIMT does not address
Pediatric CIMT
T/F: If we start CIMT early on in children, we will develop better motor plans?
Does CIMT address spatial and temporal coordination of the two hands impairments in children?
NO
- Activities that are meaningful and enjoyable - including video games
- age of child and preferred tasks
- family activities and family values
- attention span
- use of virtual reality-based and video gaming protocols is gaining momentum in rehabilitation
Salience of motor activities
The one induced is usually for gross motor tasks and more of an assist
What is the most intense (most amount of hours/day) that we can do CIMT in children?
3 hours/day
With CIMT, are adults more likely to return to dominant hand even if it was the affected hand?
True
- Measure finger dexterity in patients with neurological diagnosis
- Participants remove pegs from holes, one by one, and replace them back into container
- Board placed at clients midline, with container holding pegs oriented towards hand being tested
- Only hand being evaluated should perform test
- Other hand allowed to hold edge of board in order to stabilize
- Score: time taken to complete the test in seconds
- Alternative scoring - the number of pegs placed in 50 or 100 seconds can be recorded
- Results are expressed as the number of pegs placed per second
Nine hole peg test
Instructions: "Take the pegs from the container, one by one, and place them into holes on the board, as quickly as possible. Then, return the pegs one by one to the container with the same hand. You may only use your other hand to steady the board"
Stopwatch starts the moment the patient touches the first peg until the moment the last peg hits the container
9 Hole Peg Test
- s/p CVA
- AVM
- s/p AVM rupture
- Brain tumor
- CP
- any diagnosis with hemiparesis with neural recovery possible
- Brachial plexus injury (not at birth)
Conditions appropriate for CIMT