Constraint induced movement therapy (CIMT) creates its effects via two separate but linked mechanisms:
Overcoming learned non-use: Restraining the stronger arm while undergoing CIMT gives
the opportunity for the person to use their weaker arm
in situations where they previously most likely used their stronger arm completely. With the sole focus being on
their weaker arm, and positive reinforcements by the therapist, the person’s motivation to use their arm
increases as they reach new successes in their weaker
arm and over-come learned non-use.
Use-dependent cortical reorganization: Intense training of the upper limb during CIMT has been shown to reorganize the brain activity which is known as use-dependent cortical reorganization or neuroplasticity. The brain is capable of overcoming the damaged area by adapting to make new connections, essentially re-wiring itself as a result of mass practice and increased motivation drive.
A physical therapist will work exclusively one on one with each patient to practice a behavioral technique known as shaping. The therapist will act as a coach, encouraging and guiding the patient as the patient repeats timed exercises. This positive reinforcement and one on one interaction is key to the success of CIMT. As each patient is unique, the program will be tailored to meet the individual patient’s ability, level and goals. Exercises simulate activities of daily living and functional tasks. Real life is exercise, so that the patient will find it easy to continue their program in their home setting once the clinic is completed. The patient’s unaffected arm will be placed in a protective mitt for 90% of their waking hours. The mitt reinforces the use of the affected arm and prevents compensation by the unaffected arm, which over time helps to “rewire” the brain. If possible a family member or caregiver is strongly encouraged to be present as well, to reinforce the activities be performed in the home outside of clinic hours and to help with follow through.
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