CONSTRAINT INDUCED MOVEMENT THERAPY

Theories Of Constraint Induced Movement Therapy (Cimt) Supporting The Functional Recovery Of The Upper Limb Following Stroke - A Narrative Review

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DateTable of Contents

Chapter One: Introduction3

Objective of study3

Importance of the Research3

Chapter Two : Literature Review6

Chapter Three: Research Methodology25

Chapter Four: Analysis and Discussion68

Chapter Five: Conclusion71

References76

Bibliography87

Chapter One: Introduction

Objective of study

Upper extremity motor weakness following stroke seems to be associated with limitations in arm functions (Gresham, 1975). CIMT is one of the neurorehabilitation techniques to improve the upper limb functions after stroke. The aim of this review is to analyze the theories of CIMT supporting the functional recovery of the upper limb following stroke.

Importance of the Research

Tuke (2008) carried out a review on CIMT to identify the factors relevant to the implementation of CIMT in clinical setting. Several systematic reviews have been carried out to evaluate the effectiveness of CIMT in stroke patients. However, knowledge of the theories of CIMT namely the learned non-use theory and motor learning/re-learning theory is essential to understand the rationale behind the functional recovery of upper limb after stroke. This research will help to delineate a better understanding of the theoretical perspective of CIMT substantiating the functional recovery of upper limb following stroke.

Constraint-induced movement therapy (CIMT), a new remedy for the upper limb following stroke, has appeared from the notion of learnt misuse and has been cited as one of the few neurorehabilitation methods evolved from a scientific and theoretical foundation . early investigations on the effect of somatosensory deafferentation in monkeys proposed that throughout a time span of diaschisis, recurring unsuccessful attempts to use the paretic upper limb produced in the monkey learning not to use that limb. This phenomenon, termed 'learned non-use', proceeded after the diaschisis had passed and the limb was potentially functional. However, the submission of training techniques and/or constraint increased the spontaneous use of the paretic limb. It was subsequent hypothesised that wise non-use could happen in humans after stroke, and that the application of appropriate training regimes could decrease wise non-use and boost spontaneous use of the paretic limb . The method consists of two constituents: constraint of the non-paretic top limb; and shaping incremental repetitive task try . The blend of these is considered to cause extinction of the wise non-use, producing in important improvements in hasten of task performance, purposeful proficiency and advanced use of the paretic top limb .

Asystematic reconsider of randomised controlled trials of CIMT in stroke concluded that 'CIMT may advance upper limb function following stroke for some patients when compared to alternate or no treatment' . This conclusion was subsequently supported following a meta-analysis of the effectiveness of CIMT . The culmination of a large randomised controlled trial verified that CIMT makes statistically important alterations in upper limb function, which were maintained at 1 year . The nationwide Clinical Guidelines for Stroke suggested the use of CIMT in patients with at smallest 10 qualifications of active wrist and digit elongation, who are more than 1 year post stroke and who ...