CIMT

Constraint-Induced Movement Therapy (CIMT) is a rehabilitation approach used to improve function of the affected upper limb after brain injury, most commonly stroke. It combines restraint of the non-affected limb with intensive practice of the affected limb to overcome learned non-use and promote motor recovery.

Rationale and mechanism: After brain injury, individuals often rely on the good arm, leading to reduced use and cortical remapping of the impaired limb. CIMT aims to shift behavior and promote neuroplastic changes by forcing repetitive, task-specific use of the paretic limb while the constraint limits compensatory movement of the unaffected arm.

Typical protocols include two main forms. Traditional CIMT uses a constraint (such as a mitt) on the unaffected limb for about 90% of waking hours during a 2–3 week period, along with about 6 hours per day of supervised therapy for the affected limb. Modified CIMT (mCIMT) reduces restraint time and/or therapy duration, for example 3–6 hours per day of constraint with 1–2 hours of training, sometimes combined with home practice.

Evidence and outcomes: Evidence indicates CIMT can improve upper-limb motor function and daily activities in some stroke survivors, with effects lasting months in many studies. Benefits are generally greater in individuals with less severe impairment, in the subacute to chronic phases, and when therapy is task-specific and high-intensity. Limitations include variability of response, access to trained therapists, and adherence to intensive schedules.

Indications and safety: CIMT is typically considered for unilateral upper-limb weakness after stroke or other CNS injuries, in the absence of contraindicating pain or severe spasticity. Candidates should be medically stable and able to participate in multiple sessions; programs should be supervised by therapists to tailor tasks and mitigate risks.