CIMT Flashcards
(27 cards)
neuroplasticity
form new neural connections in response to training and practice and to compensate for injury
What happens if pt is given tasks too easy?
task given to lower centers of brain like reflex, no neuroplasticity and remodeling
monkey study
complex movement resulted in more functional learning for efficient completion of task rather than isolated training/practice of one movement
due to neuroplasticity
how do brain motor maps change with skill learning?
before: wide activation of areas in motor map
after: more efficient activation and more specific localized areas light up due to neuroplasticity
learned non use theory
pt loses level of function on paretic limb
attempts to use limb are unsuccessful which reinforces non use of limb and compensation with other uninvolved limb
even when limb is potentially recovered enough for use this non use persists chronically
“use it or lose it”
mechanisms of action for CIMT
thought process behind CIMT
eliminate learned non use through constraint
use-dependent cortical reorganization
use-dependent cortical reorganization
repeated and sustained practice causes increasing cortical representation of the involved UE being used
flow of learned non use theory (diagram)
suppression of ability due to subacute conditioning causes learned compensation of non paretic limb
learned non use leads to low spontaneous hand use and poor functional ability, vicious cycle bc disuse causes diminished cortical representation decreasing fx further
theory of CIMT based on learned nonuse
eliminate suppression of ability and learned compensation to increase spontaneous hand use and function
create altered cortical representation with task practice
traditional CIMT program dosing
4-6 hours 5x week 2-3 weeks
wear mitt 90% waking hours
modified CIMT dosing
1-2 hours 3-5x week 3-4 weeks
wear mitt 5-6 hours daily
elements of CIMT
intensive task oriented training: task practice, shaping
behavioral strategies: bxal contract to commit to wearing mitt, diary of home activity
restrict uninvolved UE
shaping in CIMT
Shaping is a training method in which a motor task is gradually made more difficult.
Shaping programs are individualized, consisting of 10-15 tasks selected primarily from a basic battery of tasks. Each task is usually performed in a set of 10-30 sec trials.
At the end of each set of 10 timed trials, the task is changed one parameter at a time
provide feedback after each trial
task practice in CIMT
Task practice is repetitive practice of individual functional/relevant/challenging tasks that takes roughly 15-30mins. Rest is provided as required.
Infrequent encouragement (i.e. every 5 mins) Global feedback at the end of the task on overall performance
progression of shaping
change task one parameter at a time
goal to increase repetitions of task or reduce time to complete task in one effort
massed practice
little or not rest between performance of skills
much more practice time than rest during session
LE activities for CIMT
cycling
aquatics
fxal str training
weight transfer
stairs
walking, surfaces
treadmill
standing/balance
behavioral contract
signed contract w PT, pt, caregiver agreeing pt will wear mitt 90% waking hours, use involved extremity as much as possible, perform HEP
remove glove for safety reasons
caregiver agrees to assist, supervise activity with mitt on, remove mitt when pt will be unsupervised
home diary in CIMT
list activities done w involved limb, time of day, number of trials, success or not
compliance with mitt
motor activity log
self report of amount and quality of use of involved UE for 30 tasks including opening drawer, eating with a fork, etc
how do you restrain LE?
you don’t, you do activities focused on increasing reliance on involved LE
training non dominant hand
fine motor skills
not tasks done w dominant hand only
however use involved limb appropriately to assist dominant hand or in BL activities
UE movement critera
CIMT: 20 wrist ext, 10 IP/MCP extension
mCIMT: 10 wrist ext, 10 thumb add., 10 IP/MCP ext of 2 fingers
motor activity log
structured subjective interview
self reported rankings of 30 specific tasks
series of questions ranked 0-5 on how much they used affected arm for task as compared to baseline
