Constraint-Induced Movement Therapy for Cerebral Palsy: How It Works

Constraint-induced movement therapy (CIMT) is a therapeutic treatment technique that, as its name suggests, involves restraining one limb of the body to promote increased movement and use of the opposite limb. In those with cerebral palsy, CIMT is commonly used to increase use of an individual’s affected arm by restraining their unaffected arm. But can constraint-induced movement therapy for cerebral palsy really improve arm and hand mobility?

To explore this question, this article will explore:

• What is constraint-induced movement therapy?
• Who can benefit from CIMT?
• How does CIMT work?
• How the brain rewires itself
• Example activities

What is Constraint-Induced Movement Therapy?

Constraint-induced movement therapy is a practice used by occupational and physical therapists to promote upper-limb functions in people with neurologically-based motor disabilities. Although CIMT was originally developed to be used with individuals following stroke, its use has been expanded to treat other central nervous system conditions, such as cerebral palsy.

It involves 2 key components:

First, the unaffected arm must be restrained using a splint, glove, mitt, cast, or sling. This will promote use of the affected arm, as it is more readily available for use.

Second, the affected arm must undergo intensive therapy to learn how to move and function accurately.

By encouraging use of the affected arm, you’re stimulating the brain to strengthen associated movement pathways. Although it can be modified, this treatment is generally fairly extensive, and individuals are encouraged to use only their affected arm for the majority of the day while participating in therapy to achieve the best results.

Who can Benefit from Constraint-Induced Movement Therapy for Cerebral Palsy?

Many individuals with cerebral palsy may benefit from constraint-induced movement therapy, as it was designed to treat upper limb deficits in individuals with neurological conditions. CP is a neurological disease, caused by damage to the developing brain. This damage results in a variety of motor impairments, including differences in muscle tone, coordination, and posture. Depending on the location and severity of the damage, different areas of the body can be affected.

For example, some people have motor impairments primarily in their legs (diplegia), while others may be affected on one side of their body (hemiplegia), in one limb (monoplegia), or all over (quadriplegia).

Constraint-induced movement therapy is ideal for those with hemiplegia or monoplegia, when only one arm has motor impairments. It can be used for individuals of any age, with studies demonstrating effectiveness in adults as well as in infants as young as 3 months of age.

Although it is unclear how the severity of motor impairments in individuals with CP affects CIMT outcomes, most studies demonstrating the effectiveness of CIMT focused on those with moderate motor impairments. While various range of motion measurements have been proposed as predictors of optimal CIMT results in individuals following stroke, no such predictors have been established for those with CP.

Even though CIMT has been mainly utilized in treating individuals with affected arm or hand movements, there is a possibility that it could also help improve leg functions in individuals with hemiplegic cerebral palsy.

Research on CIMT for improved leg function has mainly focused on individuals following stroke, however many of the same principles could carry over to its use with individuals with cerebral palsy. Ask your therapist for more information.

Finally, as the intensity of many CIMT programs can be challenging and tiring, individuals undergoing CIMT should be motivated to improve for optimal results.

How does Constraint-Induced Movement Therapy Work for Individuals with Cerebral Palsy?

Often individuals with hemiplegic or monoplegic CP will begin to compensate for their motor impairments early in life by using only the arm on the typically functioning side of the body. Just like the popular saying “use it or lose it”, when the affected arm is used less frequently, it loses its ability to function as easily.

As children continue to develop and learn that it is easier to play and perform other daily activities with their unaffected arm, the functional skills of their affected arm will decline until they eventually stop trying to use their affected arm altogether.

Even if the affected arm has very mild motor impairments, most children with hemiplegia will favor and use the unaffected arm while disregarding the affected one. This habit of learning to use primarily one arm due to motor impairments in the opposite arm is referred to as developmental disregard.

Being able to use only one arm can make it very challenging to participate in play and perform activities of daily living independently. Using only the unaffected arm can also contribute to the development of abnormal movements or musculoskeletal deformities.

Children with developmental disregard will likely find CIMT difficult and uncomfortable because they never learned how to use their affected arm. However, when stimulated, the brain has the capacity to adapt and learn to use the affected arm functionally.

How CIMT Helps the Brain Rewire Itself

This is where the concept of neuroplasticity comes into play. Neuroplasticity is the brain’s ability to rewire itself that allows functions affected by brain damage to be improved or recovered.

Constraint-induced movement therapy works because it implements the fundamentals of neuroplasticity. The best way to promote neuroplasticity is to perform task-specific, high-repetition movements (which is exactly what constraint-induced movement therapy does).

CIMT focuses on improving arm and hand functions through functional exercises that require you to continuously use your affected arm. The more you practice using your affected arm, the more neural rewiring and strengthening occur.

The stronger the neural pathways for a movement become, the more intuitive the movement feels. Ideally, accurate movements with the affected arm and hand would become second-nature and no longer require much extra effort or concentration.

While CIMT is a great way to boost arm and hand functions, it is just one of many approaches that optimize neuroplasticity. Consider discussing which strategies are best for you for increased functional performance with your physical or occupational therapist for more personalized information.

Example Activities Used During Constraint-Induced Movement Therapy

There are no specific tasks that have to be used for constraint-induced movement therapy. Typically, the most effective activities are those that are engaging, highly repetitious, and appropriately challenging. Depending on the age and interests of the individual, CIMT may focus on activities of daily living (getting dressed, eating, grooming, etc) or play activities.

Examples of activities that can be used during CIMT for cerebral palsy include:

• Daily activities: These are great for older children and adults alike, and may include sorting silverware, picking up crackers or berries, turning a doorknob, opening cupboards or drawers, and pressing buttons.
• Games: These often involve picking up and manipulating small items such as dice, playing cards, dominoes and game pieces.
• Play activities: These can be tailored to a child’s interests, such as building a tower with blocks or Legos, finger painting, playing with cars, moving small dolls in a dollhouse, and throwing a ball.
• MusicGlove: This is fun, engaging device that involves wearing a sensorized glove while moving the fingers to the beat of a musical game. The glove will track your movement and allow individuals to be intensively training their affected hand without feeling like they are having to do exercises!

Discover more activities you can practice with constraint-induced movement therapy»

While these are just examples, they are all great ways to encourage repetitive movements to improve arm and hand functions through neuroplasticity. Following CIMT, it is important to continue not only using your affected arm, but also to work on using both of your arms together. Bimanual activities that may encourage this include stringing beads, shuffling cards, cutting with scissors or a knife and fork, and washing dishes.

An occupational or physical therapist can help you discover which activities are best for you and adapt them to your specific skill level for a just right challenge.

Understanding Constraint-Induced Movement Therapy and Cerebral Palsy

In summary, constraint-induced movement therapy is an effective treatment technique to boost mobility in affected arms and hands of individuals with hemiplegic or monoplegic cerebral palsy. It can be used with both children and adults to combat developmental disregard and increase functional use of the affected arm and hand. CIMT is one of many therapeutic techniques used to boost arm and hand functions by optimizing neuroplasticity.

Ultimately, the best results are going to come from how many repetitions of affected movements you perform. Find what motivates you and keep practicing!