Constraint Induced Movement Therapy (CIMT) is used to treat people with Hemiplegia by constraining or restricting movement of the non-affected hand to force a person to use their affected hand. 

using-neofect-smartglove-to-maximize-constraint-induced-movement-therapy

Constraint-Induced Movement Therapy

Constraint-Induced Movement Therapy (CIMT) is used to treat people with 
hemiplegia [https://www.neofect.com/us/blog/hemiplegia-vs-hemiparesis] by
constraining or restricting movement of the non-affected hand to force a person
to use their affected hand. The idea capitalizes on neuroplasticity to encourage
intensive repetitions of movements, which create stronger neural pathways to
move the affected hand.

CIMT has been extensively studied for people with hemiplegia as a result of
stroke or cerebral palsy. It has been shown to be an effective therapeutic
approach to increase spontaneous use, quality of movement, and improve the
ability to engage in daily activities.

The key components of CIMT are constraining the non-affected arm and intensive
shaping. There are a variety of constraints used and none of them have been
shown to be more effective than another. People have used casts, splints, and
mitts. Intensive shaping refers to intensive repetitions of movements and tasks
that are designed to become progressively harder.

Neuroplasticity

The brain changes throughout our lifetime. We do create habits and strong neural
connections as we get older, but even if the brain is damaged and the signal
from the brain to a muscle is impaired, the brain is able to rewire itself to
create new pathways. We develop these pathways with intensive repetitions. This
is called neuroplasticity
[https://www.neofect.com/us/blog/using-brain-plasticity-to-supercharge-your-brain]
.

The brain is neurologically wired to complete an activity in the easiest way
possible. After a stroke, it’s easier for the brain to compensate with other
body parts then to send a signal to your affected hand (i.e. you’re more likely
to use your mouth to open a snack package then attempt to grasp with your
affected hand). It’s not that people are “cheaters”, their brain is using
adaptations to be the most efficient. But we also know that if you don’t use it,
you lose it. So how can we get those intensive repetitions in if the brain is
telling us there’s an easier way? That’s where CIMT comes in.

The mechanism by which constraint-induced therapy is not fully understood, but
hypothetically if you can make your brain believe that your non-affected hand is
less useful than your affected hand AND your brain is making every effort to
complete a task, the brain will start working on sending better signals to the
arm that is not constrained.

In CIMT we focus on sending signals to the muscles to move our arm and hand in
specific ways because there are certain movements that improve function.

Movements and Function
Every person is unique when it comes to what movements and joints are used to
complete a task, but there are several movements that assist us in being the
most effective and efficient: supination, wrist extension, wrist radial/ulnar
deviation, and finger flexion/extension. We need to practice these motions over
and over until our brain is able to send a signal to the muscle easier. When
doing CIMT, occupational therapists recommend a wide variety of activities to
elicit these movements.

Supination

Turning the palm up towards the ceiling, even a little, helps us hold large
objects, feed ourselves, stabilize a bottle to open, hold our phone to access it
with our other hand, hold paper to cut with scissors, and manage buttons.

Activities to practice supination:

 * Throwing a beanbag or ball underhand
 * Scooping sand or water with a small cup
 * Turning a rain stick or glitter wand over
 * Playing musical instruments, such as cymbals
 * Card games/flipping cards over

Wrist Extension

Bending the wrist up and down helps our fingers open and close to provide a more
effective grasp then simply moving our finger joints. Try it out: bend your
wrist downward completely and hold it there, now try to pick up a coin from the
tabletop without sliding it to the edge. Then try to simulate placing the penny
in a vertical slot the way a vending machine slot would be positioned. You might
be able to pick up the coin, but I guarantee you no matter how hard you
compensate with the rest of your body, if your wrist is completely flexed, you
won’t be able to get the coin where it needs to be.

Wrist extension helps us be more successful with activities such as putting
socks and shoes on, pulling up our pants, holding a glass, zipping a zipper, and
tying shoes.

Activities to practice wrist extension:

 * Rolling dough to make large pretzels
 * Washing windows or mirrors
 * Working on a vertical surface (fridge, mirror, wall, whiteboard, bulletin
   board, easel, etc.); place or remove stickers, magnets, velcro, push pins,
   etc

Wrist Radial/Ulnar Deviation

Bending the wrist side to side is radial and ulnar deviation (think about your
wrist moving like a windshield wiper). Radial deviation is moving the wrist to
the thumb side. I remember it by “thumbs up when something is rad!” (radial
deviation), and ulnar deviation is moving the wrist towards the pinky side. I
don’t have a trick for this one, I just know it’s the other one. :)

Having the ability to move the wrist into radial and ulnar deviation is helpful
for eating with a fork or spoon, buttoning pants, brushing hair, pouring from a
pitcher, and zipping a zipper.

Activities to practice radial and ulnar deviation:

 * Playing drums with a drumstick
 * Putting money in a vending machine
 * Turning a nut on a bolt
 * Turning a door knob

Finger Flexion and Extension

Opening and closing the fingers is needed to pick up or stabilize objects.
Flexing the fingers creates a gross grasp that is good for holding a cup,
pushing a grocery cart, holding a fork for cutting with a fork and knife, and
opening a jar.

Activity ideas to work on finger flexion and extension:

 * Carrying a bucket
 * Pushing a grocery cart
 * Squeezing a stress ball
 * Pulling a rope

NEOFECT Smart Glove

When it comes to neuroplasticity it’s all about repetitions. In a typical
therapy session, one can expect to complete 20-30 repetitions of movement by
completing activities that incorporate the movements above. With the NEOFECT 
Smart Glove [https://www.neofect.com/us/smart-glove], you can get up to 200-300
repetitions in a 30 minute session.

The other key feature of the Smart Glove is the algorithm and the ability to set
the parameters of the game to your movements. The Smart Glove and the software
allow you to complete a game within your capabilities and then pushes you a
little further by progressively making the demands of the game more difficult,
which is the concept of intensive shaping.

The NEOFECT Smart Glove is only one piece of the rehab journey in CIMT.
Isolating movements create stronger neural pathways to specific muscles so that
when you go to complete a functional task, you’re more likely to utilize those
muscles, but there are many ways to accomplish a task. You use a combination of
muscles to coordinate your movement. When it comes to intensive repetition for
neuroplasticity, you also need to do intensive repetitions of a functional task
to work on coordinating multiple muscles to work together. You can do this by
incorporating the self-care activities you already do everyday as your
“exercises”. Be on the lookout for the NEOFECT [https://www.neofect.com/] 
connect app that will show you how to work your training into everyday life.

To learn about how the Neofect Smart Glove can help you perform repetitive
exercises in a fun and motivating way during CIMT and beyond please call us at
888-623-8947 or email us at contactus@neofect.com. Our occupational therapists
[https://www.neofect.com/us/therapist] are available to help you on your rehab
journey!

References:

 1. Yu-Ping Chen, Stephanie Pope, Dana Tyler, Gordon L. Warren
    Clin Rehabil. 2014 Oct Effectiveness of constraint-induced movement therapy
    on upper-extremity function in children with cerebral palsy: a systematic
    review and meta-analysis of randomized controlled trials.
    [https://www.ncbi.nlm.nih.gov/pubmed/25125440]; 28(10): 939–953. Published
    online 2014 Aug 14. doi: 10.1177/0269215514544982
 2. Kwakkel, G., Veerbeek, J. M., van Wegen, E. E., & Wolf, S. L. (2015). 
    Constraint-induced movement therapy after stroke
    [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4361809/]. The Lancet.
    Neurology, 14(2), 224–234. doi:10.1016/S1474-4422(14)70160-7
 3. Shin, J. H., Kim, M. Y., Lee, J. Y., Jeon, Y. J., Kim, S., Lee, S., … Choi,
    Y. (2016). Effects of virtual reality-based rehabilitation on distal upper
    extremity function and health-related quality of life: a single-blinded,
    randomized controlled trial
    [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4765099/]. Journal of
    neuroengineering and rehabilitation, 13, 17. doi:10.1186/s12984-016-0125-x

Additional References:
Constraint Induced Movement Therapy:
Cleveland Clinic - Constraint-Induced Movement Therapy
[https://my.clevelandclinic.org/pediatrics/departments/constraint-induced-movement-therapy]
Physiopedia - Constraint-Induced Movement Therapy
[https://www.physio-pedia.com/Constraint_Induced_Movement_Therapy]
Canadian Partnership for Stroke Recovery - Constraint-Induced Movement Therapy
-
Upper Extremity
[https://www.strokengine.ca/en/intervention/constraint-induced-movement-therapy-upper-extremity/]
Neuroplasticity:
Brainworks - What is Neuroplasticity
[https://brainworksneurotherapy.com/what-neuroplasticity]
ScienceDirect - Neuroplasticity
[https://www.sciencedirect.com/topics/neuroscience/neuroplasticity]

All content provided on this blog is for informational purposes only and is not
intended to be a substitute for professional medical advice, diagnosis, or
treatment. Always seek the advice of your physician or other qualified health
provider with any questions you may have regarding a medical condition. If you
think you may have a medical emergency, call your doctor or 911 immediately.
Reliance on any information provided by the NEOFECT website is solely at your
own risk.