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The Slánú CIMT Programme

What is Constraint Induced Movement Therapy (CIMT)?
After a stroke, regaining strength and function in your affected hand and arm can be challenging. Constraint-Induced Movement Therapy (CIMT), sometimes referred to as CI Therapy, involves intensive training of your affected upper limb while restricting the use of the other hand using a mitt. The idea is to encourage you to only use your affected hand in day to day activities.
Who can benefit from this type of stroke rehab?
The best candidates for CIMT are people who:
Are highly motivated to train hard

  • Have a clear idea of what they want to improve (eg writing, hobbies, work activities)
  • Already have some voluntary active movement in the wrist (approx 200 of movement called wrist extension)
  • Already have some ability to straighten at least 2 of their fingers (approx 10 degrees)
  • Have the stamina to carry out intensive training
  • Have sufficient comprehension skills and ability to focus
  • Support from a friend or family member
  • Good standing balance with less affected hand in a mitt
  • Ability to safely move around over a variety of different surfaces with less affected hand in a mitt

What can I expect from the Slánú CIMT Programme?
Week 1: Induction into the programme and preparation on how to carry out your intensive training, including getting accustomed to wearing a mitt. This involves direct contact with your therapist/coach either onsite or online in addition to selected pre-training and pre-reading (independent practice and online Slánú tutorials and videos). Readiness to learn….recognition of what works for you, does not (also nb lack of insight into indiv condition), just in time learning
Week 2: Onsite assessment (day 1) which includes the development of your personalised plan, followed by daily 1:1 training with Slánú coach in Slánú House in Killarney, Co. Kerry. Each day consists of 3 hours training in the morning or afternoon, depending on your preference and energy levels (see below key elements of training). You are also required to carry out an additional 1 hour of independent practice off site to compliment your on-site training.
Week 3: This week has the same format as week 2, with a re-assessment on your final day (day 10)
Week 4: This week focuses on your individual Progress Review and recommendations for ongoing independent training and problem solving and may be either online or onsite, depending on your preference. …review of effective learning
An optional 3-month follow up appointment can be made with Slánú Stroke Rehab to check progress and offer additional guidance if desired.

Key elements of CIMT Training:

  • Consistent high-dose training over 2 weeks
  • Shaping
  • The Slánú Stroke Rehab coach gradually increases the challenge of the activity when appropriate to promote progression of ability. ”a method in which a behavioural objective is approached in small steps, such that the improvement required at any time is small” (Taub, 2002)
  • Encouragement and positive verbal correction allows for a transparent training environment to foster tangible results
  • Daily independent Task practice
  • Behavioural contract
  • Task specific training

Sample training day (day 9) to be completed…please come back later
Time
Activity

10am
Review of motor activity log and independent practice

10.20am

10.45am

11am
Break

11.15am

11.30am

11.45am

12pm

12.15pm

12.30pm

12.45pm

1pm
Finish morning session

Further information
The term “CIMT” is used to describe the original technique which involves a very intensive programme (approx 6 hours a day for weeks). More recently, research had investigated the benefit of a more manageable “modified CIMT” (mCIMT), which has the same core principles as CIMT but with less time wearing the mitt and fewer hours of practice each day.
Slánú Stroke Rehab offers the mCIMT programme – intensive practice that involves 1:1 personalised training with a Slánú coach/therapist and an additional 1 hour of independent practice. Participants are required to wear the mitt as much as possible during the day (during the hours of practice and as much as possible during waking hours).
Research into CIMT
This type of upper limb rehabilitation has been investigated by high quality research studies and has been found beneficial in those people who already have some use of their arm and hand.
CIMT is the most researched rehabilitation technique available and although researchers are not exactly sure of how it works, some experts suggest that CIMT affects the nervous system by enlarging the area of the brain which controls the affected hand and arm. Given that our brains never lose the ability to rewire (brain plasticity), this rewiring happens as a result of high-dose practice of meaningful activities (real life actions).
Research studies have reported that people who practice CIMT have better control of their affected upper limb and better ability to perform daily activities when compared to people with stroke who received other forms of arm and hand therapy.
Through intensive practice, the use of a restraint on the affected upper limb, and the one-on-one assistance of your coach/therapist, people can re-learn to use their affected limb.
This training is based on the research work of the CI Therapy Research Group at the Taub Clinic (which operates out of the University of Alabama in Birmingham,USA) and the ground breaking work of Professor Edward Taub.
www.uab.edu
See www.taubtherapy.com for further information.

This CI protocol was in the EXCITE Trial http://jama.ama-assn.org/content/296/17/2095which at the time of publication was the biggest multi-site trial of a specific rehabilitation technique. Whilst the amount of individual improvement may vary according to the severity of the injury, most patients have shown a marked increase in the functional ability of the affected arm.

Neuroplasticity
The ONLY mechanism that matters (other ancillary Rx and adjuncts can complement this).
“experience-dependent neuroplasticity” = the brain changes and improves as a result of you doing and experiencing real life activities
the brain rewires itself as a result of doing (doing stuff that is important to you)

Slanu Stroke Rehab Killarney