After a stroke, patients want to become independent again as soon as possible. Common goals include independently getting up, eating, and completing personal hygiene routines. With every goal achieved, patients regain more independence and joy of life.

Patients tend to use the less affected hand more often in everyday tasks. It is faster and more accurate, and daily life is easier this way. After a stroke, the affected hand may be neglected, resulting in delayed re-learning of everyday movements and fine motor functions.

The CIMT concept is similar to the one known for children with visual impairments. If the child squints, is cross-eyed or if one eye is weaker than the other, a patch is placed over the healthy eye to train the affected eye.

CIMT therapy works similarly. The less affected limb of the patient is immobilized for a certain amount of time. This can be achieved through a brace, cast, arm sling, or glove. By immobilizing the less affected arm, patients are encouraged to use the affected arm for everyday tasks.

During CIMT, patients are supported by specially trained therapists for several hours at a time. The goal is to train everyday movements with as many repetitions as possible. Support is given for activities like eating, if necessary.

After the therapy sessions, patients are asked to keep using the affected hand as much as possible. This promotes the integration of the exercises into everyday life. CIMT for twelve days usually shows good progress.

CIMT is a time-intensive type of therapy. Rehabilitation centers do not always have sufficient time and resources to offer it.

It is common to adapt CIMT to the resources of the rehabilitation facility. For example, the CIMT concept is used during occupational therapy, while other therapies are completed without immobilizing. Sometimes, group sessions focus on the training of the affected side.

Whether an increased use of the more severely affected side at home is efficient has not yet been studied sufficiently. Still, many patients report improvements through targeted practice at home.

There are two types of home exercises. You can set aside extra time for practice or decide on a specific action that you will only complete with your affected hand. Put your healthy or less affected hand in your pocket while practicing. This helps to resist the urge to use the healthier hand to help.

With the first option, you’ll take at least 10 to 20 minutes twice daily to practice activities adjusted to your abilities with your weaker hand.

Quick hemiparesis exercises at home include the following:  

• Curl your hand into a fist and open
• Spread your fingers and relax
• Lift your wrist, then lower it
• Practice different types of grips and pinches: key grip, 2-finger grip, 3-finger grip

With the second option, select an action from your daily life that you want to complete exclusively with the affected hand.

Daily life training with hemiparesis includes the following:

• Loading and unloading the dishwasher
• Wiping down tables and other surfaces
• Opening doors
• Cutting food with a knife and fork
• Turning newspaper or book pages
• Picking up and putting down playing cards
• Operating a mobile phone
• Children will probably be happy to assist in playing “rock, paper, scissors”.

When practicing at home, it is important to keep a log of your daily exercises. Once you begin to see improvements, you can gradually increase the exercises’ duration, intensity, and complexity. Your records will help your therapist plan future therapy sessions.

Also, strength training might be a good option. Talk to your therapist about options for additional exercises.

Some patients suffer considerably from the restrictions in everyday life caused by immobilization. In these cases, switching to exercises that use both hands is advisable.

It is also important to keep an eye on balance when using CIMT. Ask your therapist if your balance is sufficient to complete the exercises in a standing position.

With CIMT, the patient must understand the point of the exercise. If the patient has trouble comprehending speech or if cognitive functions are impaired, immobilizing the healthy hand can be problematic.

There are studies looking at CIMT for the lower extremities. Here, a weighted brace was attached to the more affected leg or the exercises favored the more affected leg.

These studies showed that spasticity in the leg and strength in the knee when extending the leg could be improved. In their everyday lives, the patients reported improved walking speeds and better balance when standing, among others.

As exercising the weaker leg can be very strenuous, such exercises should always be discussed with a therapist first.

In children with CP hemiparesis may occur. Affected children are limited in their volitional movements and compensate by developing strategies to complete two-handed tasks with the healthier hand alone.

CIMT can be used for children suffering from hemiparesis symptoms due to cerebral palsy. This requires considerable support from parents and teachers. The treatment is adapted by putting the affected arm in a sling or the affected hand in a glove.

Treatment intensity must be adjusted to the abilities of the children. It´s often sufficient if the therapist places their hand on the healthier hand of the child while the child practices with the affected hand. One study showed that children’s fine motor function improved under this therapy approach.

Author: Hannes Aftenberger

Sources:

Constraint-induced movement therapy for upper extremities in people with stroke, 2015

Constraint-induced movement therapy (CIMT): Pediatric applications, 2009

Effects of Lower Limb Constraint Induced Movement Therapy in People With Stroke: A Systematic Review and Meta-Analysis, 2021