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Constraint-Induced Movement Therapy Exercises: How It Works

When movement on one side of the body is weakened due to stroke, individuals may find it easier to rely on their unaffected side. However, continuous disuse can cause you to lose even more control of your affected side (learned non-use). To improve movement on the affected side after stroke, therapists may recommend constraint-induced movement therapy exercises.

To help you understand how constraint-induced movement therapy (CIMT) can be beneficial for recovering movement after a stroke, this article will discuss how it works and share some exercises you can practice at home.

How Constraint-Induced Movement Therapy Works

To strengthen and improve control over the affected side, it’s essential to practice using it. However, the motivation to move the affected side can be low when individuals struggle with severely limited movement on the affected side.

This is where constraint-induced movement therapy can help. Although it’s a difficult form of therapy, it’s highly effective.

Constraint-induced movement therapy involves 3 steps:

  1. Restraining use of the unaffected side. This can involve wearing a thick glove or simply keeping the hand behind the back.
  2. Forcing the use of the affected side. Think “use it or lose it.” The only way to improve a function is to use it.
  3. Intensive repetition. Consistent stimulation is essential for reinforcing demand in the brain for that function.

By applying these 3 steps, individuals may be able to effectively recover motor control on their affected side.

However, it’s important to note that patients need to have at least some motor control in their affected side to participate in constraint-induced movement therapy. If you are completely paralyzed on your affected side, see our other methods for stroke paralysis recovery.

Up next, we’ll discuss the underlying mechanism that makes CIMT an effective form of treatment.

Why Constraint-Induced Movement Therapy is Effective

Constraint-induced movement therapy is effective because it stimulates the brain and promotes neuroplasticity. Neuroplasticity is the central nervous system’s ability to reorganize itself and make adaptive changes.

Stimulating the brain through consistent, repetitive, and task-specific practice encourages neural rewiring. Therefore, the more you practice, the better the brain gets at perceiving demand for a specific function.  

By consistently practicing constraint-induced movement therapy exercises, individuals may gradually develop speed, strength, and more natural movement in their affected side.

In fact, CIMT is considered the “most effective treatment regimens in physical therapy” to improve motor function in the weakened arm after stroke.

Now that you understand what CIMT is and why it can be an effective form of therapy for stroke survivors, the following section will share some constraint-induced therapy exercises you can practice at home.

Constraint-Induced Movement Therapy Exercises

Constraint-induced movement therapy is most effective when you gradually increase the difficulty level of the exercises. This helps ensure that you’re being challenged as you improve, which makes the exercises more engaging and allows you to perform more repetitions.

Below are 10 constraint-induced movement therapy exercises. It’s important to pick exercises that make you feel challenged but not overly frustrated. Attempt more difficult exercises as you get stronger.

1. One-Sided Stretches

therapist demonstrating stretches for stroke patients

For a nice warm up, start by placing your affected arm on a cane and lean forward. Do this several times to help stimulate the affected side. While CIMT calls for your non-affected arm to remain behind your back, it’s good to place this arm on top of your affected arm for stability.

2. Straight Push

therapist demonstrating how to perform constraint induced movement therapy exercise for stroke survivors with hemiparesis

Place a water bottle on a table, and use your affected arm to glide across the table and tap the water bottle with your fist. You can use your torso to initiate this movement, but pay extra attention to avoid elevating your shoulder.

Even if the movement initiates from the torso, you are paying attention to your affected arm and stimulating it with movement. This attention plays a critical role in activating neuroplasticity and is responsible for some of the therapeutic qualities of constraint-induced movement exercises.

If this exercise feels difficult, rest assured that you are stimulating positive changes in the brain by attempting to do the movement while paying close attention.

3. Play Cards with Your Affected Hand

Place your non-affected arm behind your back to play a card game like solitaire. This is a difficult constraint-induced movement therapy exercise because fine motor skills are often slower to return than arm movement. Only try this exercise if you feel challenged by it but not overly frustrated. Allow yourself plenty of time to pick up and put down cards.

4. Pressing Buttons

Practice pressing buttons with your affected hand. You can use a remote controller to practice adjusting the volume or changing the channels on your television. Another example is to practice pressing the numbers on a microwave.

Again, it can be frustrating to attempt these movements with your non-affected arm behind your back. Remember to breathe and be patient with yourself. The attention paid to your affected side helps promote the therapeutic quality of this constraint-induced movement therapy exercise.

5. Pulling a Zipper

For this exercise, put on a jacket with a zipper, which is an exercise within itself. Then, practice pulling the zipper up and down with your affected hand. This constraint-induced movement therapy exercise will help you practice gripping onto smaller objects while coordinating hand and arm movement together. Even if you only zip half an inch, it’s progress!

6. Hand Exercises

pen spinning cimt exercise for strengthening upper limbs

Skim through our hand exercises for stroke patients article and choose some to do with your affected hand only. It may help to place an oven mitt over your non-affected hand to prevent it from getting involved. Start with simple movements like “palm up, palm down” where you flip your hand up and down. When you’re ready for some serious challenge, try spinning a pen with your affected hand (a very complex movement).

7. Turning a Door Knob

Practice opening a door with your affected side. This movement requires strength in your affected hand, depending on the shape of your door knob. As with all constraint-induced movement therapy exercises, do this if it makes you feel challenged but not hopeless. This is a complex motor task and it’s something you can work your way up to if you can’t get it at first.

8. Turning the Pages of a Magazine

Turn the pages of a magazine with your affected hand while avoiding the use of your non-affected hand. If this is too difficult, use your non-affected hand to bend the corners of the magazine pages to make it a little easier to grab.

9. Throwing a Ball

The next two constraint-induced movement exercises are difficult, so attempt them when you feel ready.

Find a ball about the size of a tennis ball or smaller. Then, establish targets so that you have somewhere to aim. Grab the ball with your affected hand and practice throwing it at your targets.

Initially, your targets can be general areas or directions. As your aim improves, try to establish more specific targets to make this CIMT exercise more challenging.   

10. Trace Shapes and Handwriting

Draw different shapes on a piece of paper and place it under a piece of glass. Then, use a dry-erase marker to trace the shapes with your non-affected hand. As with all constraint-induced movement therapy exercises, keep your non-affected hand at your side. As you improve, trace more intricate designs such as your signature.

Up next, we’ll discuss how to get the most out of constraint-induced movement therapy exercises.

How to Optimize the Effects of CIMT

To maximize the effects of constraint-induced movement therapy, focus on performing as many repetitions as you can. As mentioned earlier, consistent repetition is necessary to promote adaptive changes in the brain.

In the beginning, you may only be able to perform a few repetitions. What matters is that you keep trying and strive to gradually increase your repetitions over time. Remember, every stroke is unique and everyone experiences recovery differently, at their own pace.

Be kind and patient with yourself as you participate in constraint-induced movement therapy. With consistent practice, you may be pleasantly surprised by the improvements in hand function. Best of luck on the road to recovery!

Featured image: iStock/Wavebreakmedia

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Get Inspired with This Stroke Survivor Story

Mom gets better every day!

When my 84-year-old Mom had a stoke on May 2, the right side of her body was rendered useless. In the past six months, she has been blessed with a supportive medical team, therapy team, and family team that has worked together to gain remarkable results.

While she still struggles with her right side, she can walk (with assistance) and is beginning to get her right arm and hand more functional. We invested in the FitMi + MusicGlove + Tablet bundle for her at the beginning of August.

She lights up when we bring it out and enjoys using it for about 20 to 30 minutes at a time. While she still doesn’t have enough strength to perform some of the exercises, she rocks the ones she can do!

Thanks for creating such powerful tools to help those of us caring for stroke patients. What you do really matters!

David M. Holt’s review of FitMi home therapy, 11/09/2020

5 stars

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