Constraint-Induced Movement Therapy (CIMT)

Constraint-Induced Movement Therapy (CIT) is a therapeutic intervention for people with hemiplegia involving restraint of the non-involved extremity and structured practice with the more affected extremity. It was originally designed for adults with stroke. Since 1997, our lab has been at the forefront in modifying it for children and testing its efficacy based on specific impairments in hand motor control we have discovered in our lab. CIT involves restraint of the less affected extremity of children with hemiplegic cerebral palsy, along with practice with the more affected extremity. Children are engaged in functional and play activities. We use a cotton sling rather than a cast as it is more child-friendly. We make this choice based on evidence that efficacy is not dependent on how restrictive the restraint, but instead is dependent on how one uses the affected hand, and the extent to which they are motivated. The intervention is performed in groups of children (day camps) with a constant emphasis on having fun.

Our interest in this intervention stemmed from prior work in our laboratory, in which we observed marked improvement in performance of the more affected upper extremity of children with hemiplegic cerebral palsy during the one-hour sessions in which hand function was tested (Gordon and Duff, 1999). This improvement suggests that at least part of the disability may be due to non-use of the more affected extremity, and that this specific disability may be amenable to intervention.

We were one of the first groups to apply this intervention to children (Charles et al. 2001), and we have created a child-friendly form of CIT (Gordon et al. 2005). To date more than 200 children have participated. Our recent findings suggest that CIT is beneficial for some children with CP. However, the efficacy may depend on the severity of hand impairment and perhaps attention span. Further work is required to determine the most effective age to administer it, as well as the most beneficial amount and frequency of treatment.