PT eDigest

xxxxRearming After a Stroke

Constraint-induced movement therapy (CIMT) treats people who have had a stroke or sustained injuries that lead to limitations in the mobility of one of their arms. The unaffected arm is constrained in a sling, forcing the use of the affected arm repetitively and intensively for two to three weeks. The American Stroke Association has said that CIMT is “at the forefront of a revolution” in what is regarded possible in terms of recovery for stroke victims.

This treatment might seem counterintuitive. If you have problems with one arm, would not handicapping the other make life more difficult? In the short term, CIMT might make life more complicated. But, in the long term, it can restore significant function to the affected arm, instead of allowing it to become nonfunctional through disuse.

A person who suffers loss of motor function in the arm due to neurological affliction is more likely to adapt to the most efficient way to do things after an injury. The part of your brain that controls the afflicted limb is swollen, making it difficult for the brain’s neurons to cause the arm to act. If the neurons in the affected part of your brain are not used as the swelling decreases, your brain learns not to use the affected arm.

CIMT “tricks” your brain into thinking that you must use your affected arm. A special glove that restricts the movement in your healthy arm convinces the brain to pour energy into using the less-efficient arm instead. As the swelling subsides, your brain pours more resources into using your arm, and an increased amount of motor activity returns. In fact, a 2000 study published in Stroke, a journal published by the American Heart Association, showed that brain activity actually improves with CIMT.

Physical exercise that induces use of the more-affected limb for six hours daily over two or three weeks can enhance CIMT’s role in effective rehabilitation. This includes selecting tasks that address the individual patient’s motor deficits and helping the patient carry out a movement sequence if he or she cannot complete the movement alone at first. Active and passive stretching and range-of-motion exercises can help strengthen the affected arm.

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