Can your child benefit from Constraint-Induced Movement Therapy?

By: Emily Muzzy, Occupational Therapist

What is Constraint Induced Movement Therapy (CIMT)? 
Constraint-Induced Movement is a therapeutic approach for children with one sided weakness such as hemiplegia, brachial plexus or other unilateral impairment. CIMT was originally utilized in the adult rehabilitation setting to treat post-stroke patients.  However, it was found that children with one-sided involvement could also benefit from this type of treatment. Numerous research studies have shown that by restraining the unaffected limb and intensifying  use of the affected limb, pediatric constraint induced movement therapy produces major and sustained improvement in motor function in children.

Children with one-sided involvement often experience “learned non-use” of the affected side.  Forced use of the affected side helps to regenerate neural pathways back to the brain, increasing awareness of that side.  This leads to increased spontaneity of use of the arm and improved function.  The forced use is attained by the child wearing a constraint cast on his/her uninvolved arm for a period of time each day (preferably a minimum of two hours).  The cast is made by an Occupational Therapist and is removable.  When the cast is worn, this allows for mass practice of therapeutic activities with the involved arm.

What should a child hope to gain in an intensive program utilizing CIMT?

• Typical goals of a CIMT program include improved quality of gross and fine motor skills and improved bilateral hand use for daily living tasks.
• Family education will be provided on use of the cast at home, and home program activities will be provided to promote successful use of the involved arm and hand.
• A skilled occupational therapist will help to develop specific functional goals for your child based on his/her specific needs.

Who is appropriate for constraint therapy?

• Typically, children with a diagnosis of hemiplegia, cerebral palsy or brachial plexus injury (though any child with one-sided involvement could be considered).
• This is generally used with children from 18 months to 10 years of age.  Younger children have a more plastic neurological system and greater gains may be seen with them than with older children.

After finishing a session of CIMT, one parent couldn’t believe her child’s progress after four weeks of therapy.

My child’s time in constraint camp improved his fine motor skills and he had fun while doing it!  He will always use his right side, but by putting on the cast, it strengthened his weak side and now he uses it more to support activities.

What does a session of constraint therapy look like?

• At this center, a child is seen for 4 weeks of intensive therapy, 3 times per week.  Each session lasts 2 hours per day.  The fourth week focuses on bilateral training without use of the constraint cast in order to practice functional activities with both hands.
• The therapy sessions of the CIMT program offered at this center should look like FUN!  We work hard to provide a variety of play-based activities that promote repeated use of the affected limb.
• Messy tactile play is used to promote increased awareness.  Activities like giving farm animals a bath in shaving cream, building sand castles, and finding play bugs in dirt are just some examples of the way kids can get messy with their involved hands.
• Activities to promote shoulder strengthening are incorporated through climbing over obstacle courses with ladders, slides, and tunnels.
• A variety of grasp and release activities are used.  Use of the “just right” size of objects is needed so the child can be successful.
• Activities on a vertical surface such as finger painting on the wall are beneficial for getting shoulder movement along with wrist and finger extension.
• The child will be constantly engaged in activities that will require use of his/her affected arm.

Two sessions of CIMT are offered this summer as part of our Community Based Therapy Programs.  For more information on registering, contact our Intake Coordinator at 630.261.6287. Check out the additional Community Based Therapy programs like Aquatic Therapy, Fun with Food and social skills programs  here.