For children with hemiparesis, sometimes the greatest barrier to improvement is their better-functioning limb. During constraint-induced movement therapy, the child’s preferred upper extremity is placed in a cast, and therapy is focused on promoting the use and functioning of their affected arm and hand.
The casted extremity is carefully monitored for proper circulation and skin integrity. A few days before the program ends, the cast is removed and the child practices using both arms together for everyday activities.
While the child’s arm is casted, caregivers will need to provide greater assistance with self-care activities at home. Therapists teach families the best ways to assist their children during this time. To help children maintain the progress they have made during therapy, therapists work with families to develop a customized home therapy program.
Traditional CIMT Treatment Model
Traditional CIMT treatment consists of up to three hours a day of combined occupational and physical therapy for a total of 23 weekdays (about five weeks). A long-arm waterproof cast is typically worn 24 hours a day, seven days a week, on the better-functioning arm.
Candidates for this program must:
- Have a diagnosis of hemiplegia
- Have one clearly dominant hand with age-appropriate functioning
- Be walking independently
- Be seizure-free for at least six months before starting therapy
This program is not appropriate for children who have:
- Severely limited movement in both arms and hands
- Contractures that would limit participation
- Self-injurious behavior
- Severe vision limitations
- An inability to follow simple commands
Infant CIMT Treatment Model
Infant CIMT treatment consists of one hour of physical or occupational therapy a day for 20 weekdays (about four to five weeks). A removable short-arm thermoplastic hand splint or cast is used on the child’s preferred arm as a constraint during therapy sessions, and for additional time at home during structured home program activities. These children do not wear a cast for more than one hour at a time.
Candidates for this program must:
- Be under 2 years of age and not yet walking
- Have a diagnosis of hemiplegia
- Be medically stable