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Constraint therapy is the restriction of one part of the body to promote the use of another. It is most often used when one side of the body is impaired to improve function on the other side. The approach is also known as Constraint Induced Movement Therapy (CIMT).
Almost exclusively used on the arms and hands, the better functioning side is “constrained” with a sling or big mitten to discourage its use and promote the use of the impaired side for both particularly exercises and everyday activities, like dressing or making a meal. Originally designed as a very intensive therapy, applied for 90% of awake time, modified versions with fewer hours a day are still very effective for certain patients.
Depending on the type of brain injury and your specific symptoms, a physiotherapist and occupational therapist may both be involved in your treatment plan.
Our days are filled with things we want to do, whether it’s work or play. We naturally do those things with as much ease as possible. For example, we write with our dominant hand, and if sitting down to write a letter, would never spontaneously decide to use our other hand. As such, our writing skills only ever improve in the dominant hand.
Now, imagine that one of your arms stopped working. You would naturally choose to do everything with the arm that was working. What that means though is that the affected arm never gets any exercise, so never has a chance to improve; and in fact, will continue to lose function because it is never used.
CIMT or modified Constraint Induced Movement Therapy (mCIMT) recognizes our natural instincts and combines that with the science of neurophysiology that has shown that the brain can adapt and our control of movement can improve.
Constraint therapy is almost exclusively used in cases of brain injury that affects one side of the body, such as stroke or trauma. There must be some remaining level of motor control in the affected side in order for improvement to occur.
CIMT has also been shown to be effective in children with cerebral palsy.
Is it Frustrating?
You do need to be up for a challenge! The good news is that it’s a short term commitment that can provide long term results. You do need to be committed though, coming in for appointments and doing the therapy at home. You won’t see improvement right away, but focusing on and visualizing completion of each task starts building those new neural pathways that are needed to succeed. Once you get started, you’ll want to see it through to reap the benefits.
One exercise for the arm is to place an object, like a plastic bottle in the middle of a table. The person sits down and places the affected arm on the table and tries to move the arm forward until they touch the bottle. Each time the attempt is made, the brain tries to figure out how to accomplish the task. With repeated attempts, the brain will continue to build a new pathway between the thought and the message to the control centre, and then on to the muscles.
Once you’ve gained that sort of gross motor movement, you can learn to have greater control by challenging yourself to do something more adventurous, like make pancakes. Be sure to wear a bib and have extra eggs on hand! If you can think of it in a fun way, you’re halfway there!
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