How will CIMT help?
Constraint induced movement therapy ("CI Therapy", "CIMT") has many significant benefits which have been proven through research and the use of CIMT in clinic settings. Parents whose children have participated in CIMT often report that it has had a positive impact on their function and quality of life.
The benefits of constraint induced movement therapy for the arm and hand include:
- Improved range of movement
- Improved muscle strength
- Increased amount of use of weaker arm
- Improved quality of movement
- Increased motivation to use the weaker arm in function
- Reduced neglect of the weaker arm
- Improved resting position of joints
- Decreased reliance on external devices, eg splints
- Improved independence in everyday tasks
- Improved quality of life
It is important to note that constraint induced movement therapy cannot restore an arm and hand to the same level as the unaffected side. Though the improvements can be significant and have a lasting change on the child’s functional abilities, there will still be some deficits in their upper limb resulting from the original neurological injury.
The improvements that can be made with constraint induced movement therapy will depend on several factors:
How much movement is initially available: Children tend to make a similar amount of improvement with CIMT, however this is in line with how much movement they had initially. For example, a child with a small amount of movement alongside problems with tone or sensation should make significant improvements in movement and function, but objectively their arm will be still at a lower level of activity compared to a child who starts a programme with a large amount of movement and little tonal problems. Your CIMT therapist will carry out an in-depth assessment of your child’s hand and arm prior to a CIMT Programme and will provide guidance as to what sort of changes to expect based on their findings.
Engagement of the child within / outside of therapy: The more a child is able to engage in therapy sessions, the more improvements they are likely to make. Additionally, the activities they continue with outside of therapy sessions during the programme will help to maximise the treatment gains.Your CIMT therapist will assess how well your child responds to therapy and will be able to determine whether they will tolerate a full CIMT programme. They will also provide you with guidance as to what activities to continue with outside of therapy sessions. Most CIMT therapy sessions are play-based and designed to be an enjoyable experience for the child so engagement is often not too great an issue.
How long will the changes last?: The initial changes from a programme of constraint induced movement therapy can be quite significant and surprising. However it is not uncommon for some of those improvements to decrease slightly over time, particularly as a child develops and new skills need to be acquired. Research has shown that in general the improvements from CIMT are lasting, with follow-up studies being done 6 months to 2 years after a programme has completed. Most importantly the changes made to the brain have also been shown to be lasting.
The retention of improvements can often be influenced by:
Ongoing practice with the affected side. Following the CIMT programme you will be provided with custom-made removable casts, which can be used in follow-up treatment outside of CIMT. Some children practice for an hour a day using the cast, or it can be used alongside their ongoing therapy programmes with their therapists or schools.
Bilateral (two handed) task practice. The aim of CIMT is for the child to incorporate their affected side into two handed functional tasks more spontaneously. Sometimes the child needs to learn how to do tasks bilaterally, as they may have learned to do them with just their stronger arm. Your CIMT therapist may decide to use some of the programme to concentrate on bilateral tasks, or they may provide you and your child’s treating therapy team with a programme of activities to continue with once the CIMT programme is complete.
Constraint induced movement therapy has been shown to have significant impact on a child’s level of activity and function. Each CIMT programme is tailored specifically to the child and their individual goals, so your therapist will discuss with you in depth what they expect to gain from a programme.