Types of Therapy

C.I.M.T stands for Constraint Induced Movement Therapy. CIMT is a specialised rehabilitation approach primarily used to improve motor function in individuals who have cerebral palsy or other neurological conditions predominately affecting one side. 

The concept of the therapy is to prevent the child from using their UNAFFECTED arm to encourage performance of tasks using their AFFECTED arm. It can also be used together with bi-manual therapy (using two hands together in play), which the child may transition to towards the end of the prescribed CIMT therapy programme. 

CIMT works best in young children and is based on the principle of neuroplasticity, which is the brain's ability to reorganise itself by forming new neural connections throughout life. Features of CIMT therapy include:

• Constraint: The therapy begins by restricting the use of the better arm. This restriction can be achieved through the use of a mitt, a sling, or some other device that limits the movement of the affected limb. The goal is to make the child use their affected arm as much as possible.

• Intensive Training: With the good arm constrained, the individual is encouraged to use their bad arm to engage in intensive, repetitive exercises and functional activities. This often involves activities of daily living, such as dressing, eating, and grooming. These exercises are carefully designed to challenge and stimulate the affected limb.

• Shaping: CIMT employs a shaping approach. This means that the set exercises gradually become more challenging over time. This progression is tailored to the individual's abilities and progresses at a pace that encourages improvement but does not overwhelm them.

• Massed Practice: Children undertake daily, frequent and extended practice sessions. This usually involves several hours of therapy that is self delivered at home each day. Typically a block of therapy will last up to 6 weeks.

• Behavioural Techniques: Therapists often use behavioural techniques to motivate patients to use their affected limb more effectively. This might include positive reinforcement or other strategies to encourage active participation in therapy.

• Transfer Package: CIMT also includes strategies to help children transfer the gains made into their daily lives. Often at the end of a CIMT therapy block a transition will be made to undertaking some bimanual training. This may involve home exercises and strategies to incorporate the use of the affected limb into daily activities.

 The underlying principle of CIMT is to create a sensory and motor-rich environment for the affected limb, essentially rewiring the brain to adapt and improve motor function. By continuously challenging the affected limb and forcing it to perform tasks it may have difficulty with, the brain is encouraged to reorganise itself and develop new neural connections. Over time, this can lead to significant improvements in motor function and mobility in the affected limb.

C.I.M.T may differ slightly between centres but generally the journey may include the following: 

• A baseline assessment and goal setting session is undertaken with you and your child. This is to set expectations as to what differences you would like to see happen. 

• Your child will be measured up and a hand mitten will be made. This will be used to cover your child’s UNAFFECTED (or in some cases less affected) hand. 

• Often sessions will be delivered in blocks of x 6 weekly therapy sessions with a therapy assistant. This is a "check in" visit to see how you are progressing with the therapy.  

• At home your child will be expected to wear the hand mitten on a daily basis for a prescribed time and you will carry out one to one play with them. 

• Guidance and play ideas are normally provided by your therapist on your weekly visits that can then be developed at home over the week. 

• A final assessment at the end of the therapy block is undertaken, to see if the intervention has made a difference and whether the goals have been achieved. 

• A follow up will be arranged for servile months later. This is to check with you and your child to see if any further therapy blocks are required. 

C.I.M.T will not work for your child without you on board, as most of the work will be done through daily practice at home. If you feel you are unable to carry out such a commitment, or if it is not the right time for your child, or if the C.I.M.T. therapy is not working, you should discuss this with your therapist and alternative therapy options could be considered.

Bimanual therapy is often employed in children with hemiplegia. It can be delivered either as an intensive short-term regime or as a gradual physiotherapy programme aimed at repeated practice of two-handed games and activities such as catching a ball, getting dressed, using a knife and fork or using the affected hand as a supporting hand. Bimanual therapy has been shown to be as effective as constraint therapy in developing dexterity, manipulation of objects, improved control and co-ordination.