Frequently Asked Questions

What is CIMT?

Constraint induced movement therapy ("CI Therapy" or "CIMT") is a specialist form of treatment used in the rehabilitation of the upper limb (hand/arm) following neurological damage. This intensive therapy involves repetitive task practice using the weaker arm whilst the stronger arm is restrained in a glove/mitt for several hours a day over a number of weeks. Constraint induced movement therapy has been proven to increase functional use of a person's weaker arm.

How does CIMT work?

Constraint induced movement therapy works by helping the person to overcome learned non-use and stimulating the development of new neural connections in the brain. Learned non-use develops as a result of the person learning to compensate for their weakness by using their stronger arm. With CIMT the person is repeatedly using their weaker arm during the treatment programme and as a result they develop more efficient movements and are more likely to use their hand in function.

Who is suitable for CIMT?

Both adults and children with neurological weakness primarily affecting one upper limb (hemiplegia) can be considered for constraint induced movement therapy. The person must have a certain amount of movement already in the hand in order to participate in the programme. Our specialist CIMT therapists will conduct a screening assessment before anyone undergoes CIMT to ensure they are suitable.

How long does the CIMT programme last?

If a person is suitable for constraint induced movement therapy the programme will last between 2 and 4 weeks depending on the type of programme recommended by the specialist CIMT therapist. Clinic sessions are for 3 hours, 5 days a week.

Where does CIMT take place?

Our CIMT programmes are delivered at our clinics in Manchester or Liverpool.

How long do I wear the glove/mitt for?

When undergoing constraint induced movement therapy the person wears the glove or mitt on the stronger arm during the treatment sessions and for agreed periods of time at home. Each person will have individual recommendations and a home diary to record time spent wearing the glove/mitt.

For adults the ideal amount of time is 90% of their waking hours throughout the programme, including weekends. For children, the light-weight cast is worn 24 hours a day.

Child FAQ's

How long does my child have to wear the cast for?

The cast is worn 24 hours a day, 7 days a week for the duration of the CIMT programme. This is to allow for the changes to occur and consolidate in the brain.

How does my child shower / bathe with the cast on?

The cast should not get wet so we will recommend parents purchase a cast protector prior to a programme. We will provide you with more details about this following the initial assessment and before a programme is booked.

Does the cast hurt or harm my child?

The cast is light-weight and padded inside. It causes no physical harm to the child. Some children may get upset while the cast is being made, but we always find that children get used to the casts very quickly.

Occasionally there may be some skin irritation from the cast. This can be treated with a local cream. Casts are changed each week so that the arm can be washed and checked. There has been no detrimental effect on the stronger arm from being in the cast – no muscle wastage or loss of range of movement.

What happens if my child does not tolerate the cast?

In the unlikely event that a child has not adapted to the cast within the first few days of a programme, your CIMT therapist will discuss options with you. It is possible to make the cast removable, however this may impact upon the success of the CIMT programme. We have so far not had to address this problem because every child has managed well with the casts.

Do I stay for the therapy sessions?

Some parents stay for the duration of every therapy session, others leave their child with the therapists. It often depends on the child and how they best engage in therapy. The decision is made on an individual basis in discussion between the therapist and the parent. We are flexible with any arrangement.

Which programme is best, 3 or 4 weeks?

This often depends on the amount of activity in the arm prior to starting a programme. Generally speaking the longer the programme, the more improvements can be made, however we must take into account a child’s tolerance of prolonged therapy and the logistics of attending a programme for the parents and family.

Your therapist may choose to use some of the programme to focus on bilateral (two handed) tasks towards the end of a programme without using the cast. A longer programme allows for more time to focus on this, however we still gain significant results from 3 weeks.

The evidence base covers CIMT programmes for children from 2 weeks duration. We have found that 3 weeks is the optimal time to make a significant difference but we can discuss the possibility of a 2 week programme if your child is particularly high level in terms of arm movement. There is no evidence to support shorter programmes so we would not offer anything below 2 weeks.

What happens if my child won’t engage in therapy for three hours at a time?

Generally we don’t have problems getting children to engage in therapy as we have a range of exciting toys and activities! We ensure that there are adequate rest breaks for both the child and therapist by tailoring activities accordingly. However it can be very tiring for the child and it is normal to expect periods where the child may need a break, especially if they are younger. We often schedule in snack breaks during the therapy session, which give the illusion of a break from activities but still provides an excellent opportunity to use the arm in function!

How long do the improvements last?

Studies have shown improvements have retained on 6 month and 1 year follow ups. Some children may experience a slight drop in the improvements made over time but this is dependent upon their age, ability and follow-up treatment. See how will CIMT help for more details.

How do you measure the improvement of children?

We use a mixture of outcome measures to track the progress of your child, including taking daily videos so that at the end of the programme you can go back and look at the gains and improvements your child has achieved. Our specialist therapists are trained to carry out the Assisting Hand Assessment (AHA) which is a thorough and detailed objective assessment that evaluates hand function in children with hemiplegia. The Paediatric Motor Activity Log is used to measure how well and how often your child uses their hand in everyday activities. Both of these outcome measures are used at the start of the programme to determine your child’s baseline function, and the end of the programme to determine their progress.

What happens at the end of the programme?

Following the completion of the programme, your therapist will produce a detailed report giving an overview of the programme, analysing and explaining the results, and providing recommendations for activities to work on for your child – these could be with their current therapy team, at school or at home. For this, you will be provided with a removable cast which is made on the last day of the programme.

You will then attend a six-month follow up in one of our clinics where your therapist will re-assess your child, make further suggestions on how to progress their therapy at home or at school, and make a new cast if they have out-grown the one made previously. We encourage parents to keep in touch with our team, so that we can continue to offer advice on future treatment.

Can our own therapy team at home be trained to continue the work carried out during the programme?

At the end of each programme, our therapists provide extensive recommendations for activities to work on, to continue to progress your child’s arm and hand function. We frequently liaise with your own therapy team, whether it be private or NHS, to advise them on how to continue progressing your child’s CIMT treatment and maximise the benefits of the programme.

How frequently does our child need to receive a full CIMT programme?

At the end of each programme and at your six-month review, your CIMT therapist will recommend activities to continue with beyond the programme, in order to maximise the benefits of the treatment and continue to build on the improvements made during your time with us. We encourage families to keep in touch with us so that we can continuously offer advice and support when you need it, without necessarily having to visit us.

As children continue to grow and develop, and as they enter new phases of life the requirements of their upper limbs will constantly change. This is why occasionally it may be beneficial for a child to have a “top-up” period of CIMT, sometimes months or even years after the first programme. This is usually more common in very young children as the requirements of upper limbs change drastically in the first years of life and as they enter school age. A “top-up” programme would be shorter and less intensive than the original CIMT programme, and would be very individual to the child and their goals.

You can read through some of our case studies of children who have attended our programmes more than once, to gain an insight on their experiences.

I’d like to speak with other families who have tried CIMT. Is this possible?

We encourage families who are thinking of trying CIMT to speak to families who have already experienced one or more programmes with us. We can provide you with details of families who have a child around the same age as yours, or a similar condition, with their permission. We also have a Facebook group where potential families and families who have tried CIMT can discuss and offer eachother support and advice.

Do you carry out any group CIMT programmes?

All of our CIMT programmes are carried out with one individual at a time, alongside a therapist and therapy assistant. Your child will receive a programme fully tailored to their own personal needs and goals, which are discussed during the initial assessment.

My child has additional needs. Will they still be able to take part in the programme?

As all of our programmes are individually tailored to your child specifically, we can adapt to any additional needs that your child may have. In the past, we have treated children with impaired vision, speech and language difficulties, learning difficulties, and children who are PEG fed. If your child has any additional needs please speak to one of our therapists who will be able to give advice and make sure that the appropriate equipment and space are available.

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