ReJoycetherapy

What is Constraint Induced Therapy (CIT)?

Initially called “forced use therapy,” constraint induced (movement) therapy (CIT) is the principle of immobilizing one hand so that the participant uses only the other hand during therapy. During hand rehabilitation in stroke, for example, participants wear a mitten on their less affected hand and perform exercise tasks with only their weak hand.

For many years researchers had known that intensive exercise therapy (IET) accelerated recovery in the central nervous system. The related term “neuroplasticity” was introduced to describe the ability of the nervous system to reorganize itself after injury.

In a 2006 randomized controlled trial, stroke rehabilitation researchers found that CIT resulted in larger improvements than conventional therapy. So, it appears that CIT can be an important component of a successful recovery after a neurological injury such as stroke or spinal cord injury.

Here’s a video of Constraint Induced Movement Therapy:

What are the limitations of CIT?

In most cases, CIT providers require subjects to have a minimum level of functional movement in their affected limb. This excludes many people with moderate levels of disability. Perhaps the major limitation of CIT in its original form is the requirement that participants spend up to 3 weeks in a clinic. This can be prohibitively expensive, sometimes costing more than $20,000 for therapy, accommodation, and travel.

Only a few rehabilitation clinics offer the “authorized” version of CIT, so you may need to relocate for a period of time to participate. In most cases, this is very expensive, so it is worth contacting your insurance company before you embark on this option. Less intensive protocols have been suggested, e.g. modified CIT (mCIT) in which a therapist supervises CIT for 30 minutes/day, 3 times/week for 10 weeks and in addition the participant performs self-directed exercise tasks 5 hours/day, 5 days/week with a mitt on the less affected hand. The supervised portions can occur at home if the therapist uses a telerehabilitation link.

Finally, you can conduct a program on your own. You will set up a regimen of training exercises for yourself and wear a mitt on your less affected hand. Do a Google search for mCIT (or Modified Constraint Induced Therapy) before beginning so that you understand what’s involved. Be sure to ask your doctor or physical or occupational therapist whether they recommend self-directed mCIT BEFORE you begin

New ways of delivering Intensive Exercise Therapy (IET)

The latest approach to upper extremity rehabilitation is to use devices that provide task-specific IET of the shoulder, arm and hand. The tasks include “range-of-motion” of the shoulder and arm as well as grasp and release tasks of the hand. The latest devices, like the ReJoyce system for example, use computers to track these movements and control highly-motivating computer games.

Telerehabilitation providers are beginning to emerge online. In this case, a provider will run through an assessment with you online. Provided you fit their criteria and have physician approval, they will ship you the necessary equipment. Your caregiver will set up the equipment and the provider will schedule rehabilitation sessions with you. During these sessions, a therapist will supervise you directly using a web cam. Often, the therapist can configure the equipment in your home to match your exercise requirements. You will likely need to have your caregiver present for these sessions for safety reasons. Telerehabilitation is usually much less expensive than in-clinic rehabilitation.