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Baby Constraint Induced Movement Therapy (CIMT)



Constraint Induced Movement Therapy by wiredON Development for pediatric physical and occupational therapists

Who wouldn't be excited about a therapy that has proven benefits with the science to back it up.

Let's face it, in the field of neuromotor rehabilitation and childhood disability, almost ALL the research on therapies concludes that the research is well ...

inconclusive!

Many (many) years ago, when I first started hearing talk about Constraint Induced Movement Therapy, I can remember attending an NDT/Bobath workshop where the instructor discussed it. She said that in her opinion, we used CIMT in NDT treatment all the time when for example, you position a child in a way that restrains the good arm in order to facilitate activity in the more affected arm

Well that made sense at the time.

I think that many therapists believe that if you are restraining the good arm to get the affected arm to work, then you are doing CIMT and I was happy to go along with that for many (many more) years

until

I came across a brilliant series of podcast interviews with Dr Edward Taub, the man who brought us CIMT.

Which is why you should listen to podcasts people!

 

Now I am no expert on CIMT, but Edward Taub made it pretty clear that constraining the unaffected hand with a cast (or anything else) is an example of “forced-use” of the affected arm

and can not be called Constraint Induced Movement Therapy any more than say...

putting a child on a Bobath ball could be called Bobath Therapy.

So...

Today I'm sharing what I learned from listening to the Edward Taub interviews on the Brain Science Podcasts

which I highly recommend listening to - you'll find links to them at the end of this page

and my snow mountain analogy that I use to explain CIMT to parents

and some of the research that applies to CIMT in under two's

because that's where I've implemented it, so I'll share a bit of that with you too

Lets go...

 

To truly be doing Constraint Induced Movement Therapy, you need to include all four of these components:


Baby Constraint Induced Movement Therapy in pediatric physical therapy

1. Shaping

2. Intensive training

3. Transfer Package

4. Restraint

1. Shaping

Shaping is similar but not the same as grading.

Here's my definitions:

Grading is something a therapist does to increase competency with a new skill by breaking it down into manageable components, developing proficiency with the smaller tasks and then building the tasks up to successfully manage the more complex activity.

Shaping is the specific use of reinforcers to change (shape) an existing behavior so that it moves closer and closer to the desired response with the aim of producing a recognizable and repeatable behavior.

More on shaping later, but here's a top tip... if you want an excellent book on shaping, read


Learning about Shaping in CIMT

Not only will this teach you about shaping in a very practical, easy read, it will also teach you how to improve the behavior of

your animals,

your children and yes,

even your husband - I LOVED this book!

2. Intensive training

Everybody is talking about intensives and I think we all realize how important it is for neural plasticity, but the jury is not yet out on what intensive training actually entails. There is still uncertainty about

  • dosing - how much you need to do in a day / week / month / year

  • timing - when's the best time to start / how often and how soon should blocks of treatment be repeated