Constraint-Induced Movement

Therapy (CIMT)

• Is a evidence-based approach that is grounded in a strong empirical foundation

that has been evolving over the last two decades.
• Developed by Dr. Edward Taub of the University of Alabama at Birmingham
after a stroke patient
stops using the • Oleh Taub disebut
affected limb learned non-use

Learned non-use is a • Individuals are unable to move their

affected limb or the movements are
type of negative inefficient and clumsy and in response to
feedback this a suppression of movement occurs.

CIMT seeks
to reverse

patient engaging in
repetitive exercises with the
affected limb, the brain
grows new neural pathways.
• Constraint-induced movement therapy (CIMT)
coupled with intensive and varied exercise training
has proven to be effective in reducing spasticity and
increasing function of the hemiplegic upper extremity
in chronic stroke patients (Siebers, Oberg, & Skargren,
2010)
– patients between 6 months to 10 years post stroke. The unaffected
upper limb of each subject was constrained using a restricting
position belt for 90% of waking hours, 7 days a week, for 2 weeks and
they were each assigned individualized, upper extremity exercise
programs by a physiotherapist and occupational therapist to be
completed 5 days a week in an outpatient rehabilitation clinic.
Reduced spasticity and improved function were measured following
the 2-week treatment block and improvements persisted 6 months
later.
• The effects of constraint-induced movement therapy have
been found to improve movements that not only remain
stable for months after the completion of therapy, but
translate well to improvements of everyday functional task
(Miltner, Bauder, Sommer, Dettmers, Taub, 1999)
• CIMT dilakukan dengan cara memerintakan lengan yang
lemah secara intensif untuk aktif sedangkan lengan yang sehat
dibatasi (difiksasi)
•  The idea is to encourage you to use your weaker hand to
do daily activities
CIMT premises:

• brain can reorganize itself after sustaining

damage to the motor area, and that these
processes are facilitate through the two
principles:
– Extensive upper limb training, and
– Constraining the unaffected limb

• Is a behavioral approach to neuro-rehabilitation

of limb function after neurologic damage.
• The intervention utilizes a combination of
motor training elements and psychological
concepts to facilitate increased use of the
affected limb as well as improvement
movement quality and control

• Is designed to achieve real-world

improvements by behavioral methods which
facilitate the incorporation of regained abilities
into person’s spontaneous behavior.
• some experts suggest that CIMT affects the
brain by enlarging the brain area controlling
the weaker arm.
• Research studies have reported that patients
who receive CIMT have better control of their
weaker arm and better ability to perform daily
activities such as cooking and dressing when
compared to people with stroke who received
other forms of arm and hand therapy.
• CIMT is composed of 3 elements:
– Repetitive, unilateral training procedures (eg.
Shaping, Task practice)
Shaping is one of technique is a systematic behavioral
procedure whereby progress is achieved in small steps by
successive approximations throughout multiple times
trials that use frequent detailed feedback and
encouragement.
With adult, the shaping process is usually broken up into
blocks of ten trials each, and the repetitions of the task are
timed or the number of repetitions completed in a set
time period.
– A set of behavior techniques (transfer package)
that promote transfer of therapeutic gains to the
life situation
• Transfer package utilizes selected behavioral
techniques: home diary, behavioral contact, home skill
assignment, daily administration of the Motor Activity
Log, problem solving, and maintenance of a daily
schedule.

– Constraint of the less-affected hand by one of

several techniques
 Role of Therapists
• The role of the therapist in CIMT is to ensure
the integrity of the standard intervention
while focusing on the unique needs and goals
of each client.
• Therapists must employ therapeutic skills in
observation, listening, problem solving,
behavioral management, task analysis,
strategy development, safety awareness, and
risk assessment
 Evidence Based
• A series of studies has provided evidence that
constraint-induced movement therapy (CIMT)
improves motor recovery after stroke (after stroke
have reported superior results compared with
standard rehabilitative methods).
(Alberts et al., 2004, Blanton & Wolf, 1999;
Dromerick et al., 2000; Page et al., 2005; Ro et al.,
2006) or late (Bonifer et al., 2005; Liepert et al.,
1998; Miltner et al., 1999; Wittenberg et al., 2003).
 Effect of Constraint Induced Movement Therapy v/s Motor Relearning
Program for Upper Extremity Function in Sub Acute Hemiparetic Patients
Mithil V Shah1, Sanjiv Kumar2 , Anil R Muragod3
Indian Journal of Physiotherapy and Occupational Therapy. January-March 2016, Vol. 10, No. 1

Objectives: To determine the effect of CIMT and MRP on upper limb function and to
compare the effect of both in sub-acute hemiperatic patients.

45 participants: Group A & B

Group A received CIMT technique  The unaffected extremity was restrained for 80
percent of working hours and task oriented training was given for affected extremity
for 3 hours daily for 14 days.
Group B received the motor relearning program for 14 days.

Functions of upper limb were assessed using Nine Hole Peg Test, Motor Activity Log
and Fugal Meyer Performance measured at the beginning and after completion of the
intervention.

Result: The results of the present study showed statistical significant improvement in
MAL (p=0.001) and FMS (p=0.031) in the CIMT group. The MRP group showed
significant improvement in MAL (p=<0.001).
 Modified constraint-induced movement therapy early after stroke:
Participants ’ experiences
IRIS HELENE BORCH ,GYRD THRANE & ELINE THORNQUIST
European Journal of Physiotherapy, 2015; 17: 208–214

The purpose of this study was to gain insight into patients ’ experiences
with CIMT and to investigate how their function and daily life were
influenced during and after the treatment period.

Methods. Conducted in-depth semi-structured interviews with three men,

aged 60–70 years, in the subacute post-stroke stage, recently discharged
from modifi ed CIMT.

Results. The participants were satisfied with the CIMT in terms of

improvement in physical function in the affected arm but, when
interviewed, they reported excessive muscle activity and lack of precision
during fi ne motor activities.
 Differential patterns of cortical reorganization following
constraint-induced movement therapy during early and late
period after stroke
NeuroRehabilitation 35 (2014) 415–426

• METHODS: 17 early and 9 late subjects were enrolled. Each

subject was evaluated using transcranial magnetic stimulation
(TMS) and the Wolf Motor Function Test (WMFT) and received
CIMT for 2 weeks.

• RESULTS: The early group showed greater improvement in WMFT

compared with the late group. TMS motor maps showed
persistentenlargementinbothgroupsbutthelategrouptrendedtowar
dmoreenlargement.Themapshiftedposteriorlyinthelate stroke
group. The main limitation was the small number of TMS
measures that could be acquired due to high motor thresholds,
particularly in the late group.