Constraint Induced Movement Therapy – CIMT

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[9/8, 4:14 PM] Hardeep Sodhi: Who here has tried / is trying CIMT ? Please share your experiences. Thanks.
[9/8, 5:16 PM] Srinivas Pyati: What is cimt
[9/8, 5:23 PM] Dr. Stephen R. Christian: Constrained induced movement therapy
Or in very simple words its forced use of affected extremity
A newer n effective approach for rehabilitation of mild to moderate stroke
I have tried in my patients and in 1 patient with mild impairment within 22 days patient had recovered upto 90 % of pre stroke condition
[9/8, 5:55 PM] Akshay Patil: But the trouble is to implement CIMT you need to be in a very good condition already
[9/8, 7:12 PM] Geetha Krishna: Is it done by physiotherapist or a different Doctor?
[9/8, 7:13 PM] Akshay Patil: Physiotherapist
[9/8, 7:14 PM] Dr. Charmy Chheda: Physiotherapist as a part of rehab
[9/8, 7:15 PM] Akshay Patil: Like even though we it by right hand if your left hand is affected try to eat by it
[9/8, 7:16 PM] Akshay Patil: If the one is not doing it willing then the other hand is forcefully restricted that is called CIMT
[9/8, 7:25 PM] Hardeep Sodhi: I had put a link on CIMT yesterday, with some background :
https://www.physio-pedia.com/Constraint_Induced_Movement_Therapy
Some of Sai sanjivani videos talk of this. Their website home page clas they have ‘cured’ 50000 plus paralysis patients.

How many here are practicing this and what results have they got ?

What do the experts say ? Should one focus on this entirely and leave other efforts ? Will that have faster results ?

Please share all your experiences and knowledge, thanks.
[9/8, 7:26 PM] Dr. Charmy Chheda: Not really it means totally trying to use the affected hand by constraining the gud hand..
[9/8, 7:27 PM] Dr. Charmy Chheda: And it needs to be constrained for a gud period of the day
[9/8, 7:28 PM] Dr. Charmy Chheda: Sometimes even done for 3 to 4 weeks with plaster or tight bandages.. so patient just can’t use the gud side
[9/8, 7:28 PM] Akshay Patil: It’s good Hardeep but for many question is how to reach to the stage where they can start CIMT
[9/8, 7:29 PM] Akshay Patil: So no questions of leaving other efforts for beginners
[9/8, 7:35 PM] Hardeep Sodhi: But to me it seems to be the fastest way, if one believes the problem is in the brain then one needs to train/ work on the brain the most, isn’t it ?
[9/8, 7:35 PM] Akshay Patil: Even conventional therapist recommend it but they just tell you to do things with affected hand but don’t restrict good hand
[9/8, 7:36 PM] Hardeep Sodhi: Sai Sanjivani strongly seems to be advocating this..see video link earlier posted…
[9/8, 7:37 PM] Hardeep Sodhi: https://youtu.be/IObb3QNkLag
[9/8, 7:38 PM] Hardeep Sodhi: Would like to have more experiences from experts and any who.has tried CIMT..
[9/8, 8:18 PM] Bharti Dhankani: Exactly…this doesn’t work in the flaccid stage of recovery and can’t be explored untill the hand is good enough to function with wrist control and finger extension all in place. I knew about it at the start of my recovery but haven’t been able to take advantage of CIMt up till now as I have no finger extension.
[9/8, 8:20 PM] Akshay Patil: Still try few activities if enough strength is in hand
[9/8, 8:21 PM] Akshay Patil: Like drinking water from bottle with affected hand , no problem if you are placing bottle in your affected hand with good hand
[9/8, 8:33 PM] Bharti Dhankani: All this I am doing but that’s not a part of CIMT as I am using my good hand to place things in my affected hand
[9/8, 8:36 PM] Bharti Dhankani: CIMT works only if the hand is weak yet functional otherwise…not in case of complete paralysis of the hand
[9/8, 8:41 PM] Dr. Stephen R. Christian: CIMT is way more than just forced used
There is conundrum between using task oriented training (TOT) or CIMT, coz all the patient that can be given CIMT can also be given TOT
Although it depends on your goal your therapist view and many more things.

As far as dosage is concerned, scientifically speaking
TOT – the more the better
CIMT – 8 to 12 hrs / day for 4 to 8 weeks
MCIMT (modified CIMT)- 2 to 4 hrs / day for 4 to 8 weeks
Forced use – all the waking hrs

Research and evidence suggest mCIMT and TOT as best approach yet non is proven superior to another yet

Dr Stephen Christian (MPT NEURO)
[9/8, 9:25 PM] Hardeep Sodhi: Thanks for your inputs @⁨Dr. Stephen R. Christian⁩ . Reading up I also see that CIMT is more effective if the hand has at least some movement…but some brain re-arrangements do take place due CIMT. See :

Constraint-Induced Movement Therapy – Upper Extremity

But even if there is no movement presently why not use this in combination with regular physiotherapy, if the patient wants to do so… There is no harm, apparently..
[9/8, 9:30 PM] Dr. Stephen R. Christian: True but the core value of CIMT is in selecting the patient for it

Unlike other management researchers have found even in those who r eligible for it, tend to have high mental, physical n psychological fatigue.

So it should NEVER be given for patient moderately severe to severe impairment.
Compensatory approach or TOT would be a better choice for them.
[9/8, 10:34 PM] Hardeep Sodhi: Interesting. Here is some more data – small research in Safdarjung hospital.
https://www.strokejournal.org/article/S1052-3057(20)30796-5/fulltext

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this is the trial that was discussed yesterday. ( Zoom session, 5 th Dec. 2021) ..as can be seen there is a huge and long-term difference between a control group and that subjected to CIMT per protocol set out in the experiment…link to the article is :

https://www.ahajournals.org/doi/full/10.1161/01.STR.0000206463.66461.97

Lot of statistical data there but still may be interesting for all to read details.

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