what is neuroplasticity?
- The brain’s ability to reorganize itself by forming new neural connections in response to training and practice or to compensate for injury or
disease
what is the theory of learned non-use?
- Early after CVA - attempts to use the paretic
limb fail and there is subsequent selective
reinforcement of the use of the other (less
involved) limb –> Persists into chronic stage despite spontaneous recovery of the potential to use the limb
what are the two proposed mechanisms of action for CIMT
- eliminating learned non-use with constraints which encourages the use of the affected limb through conditioning
- use-dependent cortical reorganization is repeated and sustained practice which causes increased cortical representation of the involved UE
explain the theory behind CIMT
task practice –> increased motivation –> altered cortical limb representation due to increased use –> increased spontaneous hand use and improved functional ability
what is a traditional CIMT program?
- Patients participate in 4-6 hours of CIMT 5
days per week for 2-3 consecutive weeks - For UE programs, patients wear a mitt on
their uninvolved UE for 90% of their waking
hours during these 2-3 weeks - For LE programs, the uninvolved LE is not
restrained, but activities are focused on
increased reliance on the involved LE
what is a modified CIMT program (MCIMT)?
- Patient participates in 1-2 hours of PT
and OT for 3-5 weekly sessions over
3-4 weeks - Therapy focuses on CIMT activities
- Patients wear mitt 5-6 hours during
their waking hours that have been
identified as a time of frequent arm use
what are the 3 elements of CIMT?
- Intensive task-oriented
training
- Task Practice
-Shaping - Behavioral Strategies
- Behavioral Contract
- Home Skill Assignment
- Home Diary
- Motor Activity Log (MAL) - Restriction of the
uninvolved extremity
what are the elements of task practice?
- Functionally relevant tasks- performed
continuously for 15-30 minutes - Global feedback - is provided by the
therapist about overall performance - Challenging task - The movements can
be varied to assist the patient in
reacquisition of movement control
what is shaping? what else is it called?
- Characterized by repetitions of a defined
movement in a series of trials - Functional activities are practiced for a set of 10
timed trials with explicit feedback provided by the
therapist regarding the patient’s performance with each trial. - Patients are challenged to either increase the
successful numbers of repetitions or reduce the
time to complete the task demands successfully
within one effort - Also called “Adapted Task Practice
what are UE shaping activities?
- stacking blocks
- flipping dominos
- dealing cards
- writing
-typing
-placing clothes pins - switches/toggles/buttons
-use tongs to pick up objects
-remove jar lids
-tie shoes
what is massed practice?
- Characterized by practicing a motor skill
with relatively little or no rest between repeat
performances of the skill. - Practice sessions are set up so the amount of
practice time is greater than the amount of rest
time.
what is a behavioral contract?
- A signed contract between patient, care giver,
and therapist.
The patient agrees to:
-Wear mitt 90% of waking hours - Use involved UE/LE as much as possible
- Perform HEP as given
- NOT wear mitt for safety concerns
Care giver agrees to: - Assist with follow through of HEP
- Supervise daily activities when mitt is on
- Remove mitt when patient will be unsupervised
what is home skill assignment and practice?
Functional tasks assigned nightly to perform:
- with mitt on
- without mitt
- only with supervision
- with bilateral UE/LE
what are the expectation with a home diary?
Patient is asked to write in a diary daily the
the following information:
- List of activities done with involved UE/LE
- Time of day activity was performed
- Number of trials performed
- How the activities went (successful/unsuccessful)
- Compliance with mitt
- Any other comments
What is a motor activity log?
Subjective self-report of the amount and quality of use of the involved UE for 30 specified tasks
Examples:
- open a drawer
- use a fork for eating
- turn on a light switch
- use the TV remote control
what is the UE movement criteria?
Traditional:
- 20 degrees wrist extension
- 10 degrees extension IP/MCP each finger
Modified:
- 10 degrees of wrist extension
- 10 degrees thumb abduction
- 10 degrees extension IP/MCP of 2 fingers
Describe the Actual Amount of Use Test (AAUT)
Video of a set of task scenarios with patient unaware they are being recorded
- open file folder, remove pages, put paper in pocket, remove cards from box, turn pages, hand album to experimenter, unfold newspaper, etc.
Movement assessed by therapist for:
-Use of involved limb (yes or no)
- Quality of movement (Functional Ability
Scale)
what is the Wolf Motor Function Test (WMFT)
- 17 functional tasks tested on both the
involved and uninvolved UE - Movement is timed and assessed by therapist for quality of movement using the Functional Rating Scale
what tasks are included in WMFT
- Forearm to table
-Forearm to box - Extend elbow
-Extend elbow + (weight) - Hand to table
- Hand to box
-Weight to box - Reach and retrieve
- Lift can
- Lift pencil
- Lift paper Clip
- Stack checkers
- Flip cards
- Grip strength
-Turn key in lock - Fold towel
- Lift basket
what is the functional ability scale?
(FOR USE WITH AAUT AND WFMT)
0 - Does not attempt with involved arm
1 - Involved arm was moved during task but was not helpful (very poor)
2 - Involved arm was of some use during the task but needed some help from the uninvolved arm, moved very slowly, with difficulty, or required more than 2 attempts to complete (poor)
3 - Involved arm was used for the purpose indicated, but movements were influenced to some degree by synergy, or the movements were slow or made with only some effort (fair)
4 - The movements made by the involved arm were almost normal, but not quite as fast or accurate as normal (good)
5 - Involved arm was used for the task and movement appears normal
what other conditions can benefit from CIMT
- Lower Extremity Surgery (THA)
- Traumatic Brain Injury
- Spinal Cord Injury
- Pediatrics
- Aphasia
- Multiple Sclerosis
- Parkinson’s Disease
- Amputee - Phantom Pain
