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SANA BATOOL LECTURER IPM&R, DUHS CONSTRAINT INDUCED MOVEMENT THERAPY
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Objectives Background and Evidence Description of Components CIMT Vs. mCIMT program Further Applications
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constraint induced movement therapy A recent intervention that has gained much consideration in the treatment of post stroke paretic arm It was described by Dr Edward Taub in the late 1970s and 1980s on the basis of his initial research with primates. Monkey's one forelimb was surgically deafferented by dorsal rhizotomy, as a result monkeys were unable to use their affected forelimb despite of a great effort & developed a learned non-use phenomenon. This phenomenon is also seen in patients who experience hemiparesis following stroke.
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The treatment technique three components: First, stroke patients underwent CIMT program need intensive task training of paretic arm for six hours per day of successive two weeks. Second it involves constraining movement of unaffected arm with a sling, mitt or splint for 90% of waking hours. And, third, CIMT involves application of simple behavioral technique called shaping of hemiplegic arm which is useful in overcoming learned non use phenomenon.
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SHAPING: A BEHAVIORAL APPROACH A. Shaping: Shaping is a treatment technique that includes performing tasks such as spooning beans or blocks to a box. The tasks increase in difficulty as performance improves and frequent feedback is given immediately tasks chosen based on movement goals, potential for improvement, patient preference goal is not ‘skill acquisition’ but cortical stimulation and overcoming learned non-use Also called “Adapted Task Practice”
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Constraint Induced Therapy CIT protocol Restraint aarm/hand with a mitt or sling 90% of the time In the clinic 5 days a week 6 hours in clinic 2 weeks mCIT protocol Restraint aarm/hand with a mitt or sling 5 hours per day In the clinic 3 days a week 30 minutes in clinic 10 weeks
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Inclusion Criteria To take part in CIMT program patient’s hemiplegic upper limb should have a functional level of; ≥ 20 degrees of wrist extension & ≥10 degrees of extension of all digits Passive movement: no major contractures limiting function Able to focus exclusively on UE training for two week period (ie. not requiring other therapies for duration of CI training) Motivated and able to comply with the demands of the program
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Exclusion Criteria medical condition requiring monitoring or intervention during treatment day (including administration of medication), unless responsible caregiver present. requires assistance to transfer or toilet, unless caregiver present unable to tolerate half a day of activity (due to fatigue, pain, concentration, motivation) vision or hearing not sufficient to participate in self-rating scales
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Exclusion Criteria communication abilities not sufficient to participate in self-rating scales, unless caregiver who is knowledgeable in patient’s daily performance of activities at home present unable to provide reliable yes/no answers unable to follow one-step commands motor and functional impairments not significant enough to warrant intensive therapy
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Case Study 51 year old female, left lentiform nucleus infarct in August 2005 Rehab at Glenrose Subacute, Outpatient, CRIS Program, acupuncture, Spasticity Clinic Participated in CIMT September 2007
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Subjective Feedback “It has totally changed the way I think about using my weak arm.” “I feel like I ‘rehired’ the arm that I fired after the stroke.” “Overall, my daily life is so much easier.” “My body seems more aligned.” “I saw a lot of improvement in my family member.”
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Reaching forward Reaching sideways
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Grasping & Pouring
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Stacking Blocks
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Stacking cones
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