Trends in Field of Stroke Rehabilitation – Constraint Induced Movement Therapy

Constraint Induced Movement Therapy

One of the recent trends in stroke rehabilitation is constraint-induced movement therapy (CIMT).  The treatment involves constraining the non-affected arm in the patient who has had a stroke, forcing use of the affected arm during functional activities (Fleet, Che, MacKay-Lyons, Mackenzie & Page, 2014).  Such functional activities might include shaping of the hand to fold a towel or raise a cup or fork.  The patient must meet certain criteria before embarking on a program which is that they must have at least “10 degrees of active wrist extension and 10 degrees extension of thumb and at least two fingers”(Fleet et al, 2014).  The most famous study was the EXCITE trial  which consisted of “6 hours a day over 10 consecutive weekdays with a restraint (usually a mitt) over the unaffected arm for 90% of waking hours”(Wolf, Winstein, Miller & Taube, 2006).

Despite some positive results in the studies, such as increased function in the affected arm in the patients that met the criteria, this has apparently not translated into practice.  Fleet et al. (2014) explain that barriers to therapist’s using this method included lack of resources, not following the traditional guidelines or lack of knowledge about the therapy or how to implement it.  For example, in the survey by Fleet et al. (2014) 92% were aware of CIMT but only 42% used it.  88% of the therapists surveyed could not name the minimal criteria of arm movement required to participate in the study.

See Trends and Roles Reflections post on this topic as to how to increase knowledge on constraint induced therapy in the classroom.

Note:  Since the EXCITE study, a modified-constraint induced therapy has been trialed which I will not be covering here (see: http://www.ncbi.nlm.nih.gov/pubmed/21621674)

Fleet, A., Che, M., MacKay-Lyons, M., MacKenzie, D., Page, S. et al.  2014 Jan 30.  Examining the Use of Constraint-Induced Movement Therapy in Canadian Neurological Occupational and Physical Therapy.  Physiotherapy Canada.  doi: 10.3138/ptc.2012-61.  Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3941132/

Wolf, S., Winstein, C., Miller J., Taube, E. (2006). Effect of constraint-induced movement therapy on upper extremity function 3 to 9 months after stroke: the EXCITE randomized clinical trial.  JAMA. doi:10.1001/jama.296.17.2095.  Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/17077374

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