There is much debate at present into the efficacy of CIMT in stroke care. The Stroke Rehabilitation Unit, Baggot Street Community Hospital conducted research into aspects of this technique to assess its suitability for our client group.
Background: Constraint Induced Movement Therapy (CIMT) is a rehabilitation approach aimed at forcing use of the affected upper limb following stroke.It stems from the theories of learned non-use and use dependent cortical reorganisation.It involves restraining the unaffected upper limb, thereby forcing use of the affected limb.CIMT is usually carried out for a period of 2-3 weeks and during this time the patient participates in intensive therapy and task practice.
Review of available evidence: A systematic review of all randomised controlled trials in this area indicated CIMT may improve upper limb function following stroke for some patients when compared to alternative or no treatment (Hakkennes S, Keating L, 2005). However it is not known at present what protocols are effective and which stroke populations are most likely to benefit from it as an intervention. Further research is also required to assess impact on quality of life, cost and patient / carer satisfaction.
Summary of intervention: A modified version of CIMT was used with a group of 8 clients here in the Stroke Rehabilitation Unit, Baggot Street.Clients > 1year post stroke attended for 3 hours per day for two consecutive weeks.Their unaffected limb was restrained while they engaged in the massed practice of various activities using their affected upper limb. A second age matched group attended an identical programme with the exception of the constraint element.
Analysis of the data: Within group pre and post testing and 3 month review showed promising results for increasing activity in the upper limb in both groups.When the two groups were compared no significant difference was noted between groupssuggesting that it is the massed practice component of the CIMT intervention that confers most benefit.
These studies were presented at:
- The Irish Heart Foundation, Stroke Study Day2003 and 2004.
- Chartered Physiotherapists in Neurology and Gerontology study evening 2005.
- Association of Occupational Therapy Ireland conference 2006.
Hakkennes S and Keating JL.Constraint-Induced movement therapy following stroke: A systematic review of randomised controlled trials.Australian Journal of Physiotherapy 2005;221-231
Page et al.Stroke patients’ and therapists’ opinions of constraint-induced movement therapy.Clinical Rehabilitation 2002; 16:55-60
Siegert RJ, Lord S, Parter K. Constraint-induced movement therapy:time for a little restraint? Clinical Rehabilitation 2004; 18:110-114
Taub E, Miller NE, Novack TA et al. Technique to improve chronic motor deficits after stroke. Arch Physical Medical Rehabilitation 1993; 74:345-54
Taub et al.A placebo-controlled trial of constraint-induced movement therapy for upper extremity after stroke.Stroke April 2006