Constraint-Induced Movement Therapy
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. 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.
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.
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.
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
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, 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 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 firstname.lastname@example.org. Our occupational therapists are available to help you on your rehab journey!
- 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.; 28(10): 939–953. Published online 2014 Aug 14. doi: 10.1177/0269215514544982
- Kwakkel, G., Veerbeek, J. M., van Wegen, E. E., & Wolf, S. L. (2015). Constraint-induced movement therapy after stroke. The Lancet. Neurology, 14(2), 224–234. doi:10.1016/S1474-4422(14)70160-7
- 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. Journal of neuroengineering and rehabilitation, 13, 17. doi:10.1186/s12984-016-0125-x
Constraint Induced Movement Therapy:
Cleveland Clinic - Constraint-Induced Movement Therapy
Physiopedia - Constraint-Induced Movement Therapy
Canadian Partnership for Stroke Recovery - Constraint-Induced Movement Therapy - Upper Extremity
Brainworks - What is Neuroplasticity
ScienceDirect - 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.
- Clarice Torrey, OTR/LClarice is an occupational therapist, product designer, and health writer based out of San Francisco, CA. Clarice works for RAD Camp as a Community and Product Manager.