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Constraint Induced Therapy

Is Constraint Induced Therapy for Me?

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Updated February 21, 2009

Constraint Induced Therapy
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The concepts behind constraint induced therapy (CIT) were developed nearly a century ago when researchers realized that after a nervous system injury that impaired movement of an arm, experimental monkeys consciously avoided the use of that arm and preferentially used the “good” or intact one.

Realizing that this would certainly increase recovery time, the researchers then strapped the monkey's good arm to its body, which motivated the monkey to start using the free, but affected arm. This accelerated recovery. The researchers called this “forced therapy.”

Since then, this therapy has adopted new names, including constraint induced therapy and constraint induced movement therapy (CIMT). The benefits of CIMT were shown in a randomized control trial which was published at the end of 2006 in the Journal of the American Medical Association.

Who Can Get CIT?

The clinical trial (EXCITE), which proved the efficacy of CIMT, revealed that it worked best for people with moderate strokes affecting the arm and hand. In the trial, these patients showed functional improvement whether their stroke occurred 3 or 9 months before starting therapy, which implies that CIMT might be effective even in people who suffered a stroke years ago. Another possible requirement is preserved cognition, as this was a requisite for participation in the EXCITE trial. However, as of early 2009, no one has studied whether CIT can be used in people with mild to moderate cognitive impairment.

How Is CIT Actually Done?

As you can gather from the above, the key intervention in CIMT is forcing a person to use a dysfunctional limb as much as possible. In fact, in stroke survivors who are left with arm dysfunction, the goal is to “force them” to use only the affected arm to perform routine activities such as cooking or getting dressed.

Mittens and arm slings are used to prevent patients from using the intact arm for at least 90% of a person's waking hours. The program carries on for several weeks. In addition, patients participate in intense physical therapy sessions of the affected limb for at least 6 hours per day, up to seven days per week.

Studies have shown that this rigorous program improves function by inducing a functional reorganization of the brain.

Where Can I Get CIT?

Not all rehabilitation centers offer CIMT, and not all health insurance policies cover it. You should begin by asking local rehabilitation centers whether they offer CIT. You should then ask your doctor whether he thinks you can actually benefit from this therapy. Once you get a prescription (or referral) for therapy, you should then find out if your insurance plan will cover it.

But don't be discouraged if you are kept from the rehabilitation centers because of insurance policy issues. Experts in this subject are now advocating for home programs with the sporadic assistance of a physical therapist. And theoretically, you could do this on your own while you go about your daily activities.

Do your best. The more hours you spend doing it, the better it will be for your recovery. All you need is a mitten or a sling. Just talk to your doctor about it before you start to make sure that this is an appropriate therapy for you.

Sources:

Michael P. Barnes, Bruce H. Dobkin , Julien Bogousslavsky; Recovery after Stroke; 2005; Cambridge University Press.

Steven L. Wolf, et al; Effect of Constraint-Induced Movement Therapy on Upper Extremity Function 3 to 9 Months After Stroke: The EXCITE Randomized Clinical Trial JAMA 2006;296:2095-2104.

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