Pediatric Constraint Induced Movement Therapy

What is Pediatric Constraint Induced Movement Therapy?
Pediatric constraint induced movement therapy (also known as CIMT) is a form of therapy that encourages children with hemiplegia to use their affected arm by physically constraining the less affected arm. CIMT is offered by many children's hospitals across the country. These programs are intensive and follow a rigorous protocol.

How does CIMT work?
CIMT programs typically involve casting the child's unaffected arm anywhere from 2 hours per day to 24 hours per day for 4-8 weeks. During that time, the child also receives intensive occupational therapy, sometimes up to 6 hours per day!

What are the benefits?

• Improved use of the child's affected arm
• Improved fine motor skills
• Improved spontaneous use of the child's affected arm
• Improved bilateral coordination (using both arms together)

Is there research to support the use of CIMT?
In general, research on the use of CIMT is limited, but growing. The research that has been conducted generally reports positive outcomes.
A quick literature review of the American Journal of Occupational Therapy revealed the following studies, all of which report positive outcomes:

• Case-Smith, J., DeLuca., S. C., Stevenson, R., & Ramey, S. L. (2012). Multicenter randomized controlled trial of pediatric constraint-induced movement therapy: 6-month follow-up. American Journal of Occupational Therapy, 66, 15–23.
• Cope, S. M., Forst, H. C., Bibis, D., & Liu, X.-C. (2008). Modified constraint-induced movement therapy for a 12-month-old child with hemiplegia: A case report. American Journal of Occupational Therapy, 62, 430–437.
• Dickerson, A. E., & Brown, L. E. (2007). Pediatric constraint-induced movement therapy in a young child with minimal active arm movement. American Journal of Occupational Therapy, 61, 563–573.
• Martin, A., Burtner, P. A., Poole, J., & Phillips, J. (2008). Case report: ICF-level changes in a preschooler after constraint induced movement therapy. American Journal of Occupational Therapy, 62, 282–288.

In addition, The CanChild Centre for Childhood Disability Research has written An Update on Constraint Therapy in Children with Hemiplegia. The research in this article is a little outdated, as it has not been updated since 2006. However, it does give a good overview of CIMT, as well as a review of the research completed prior to 2006.

Where can I learn more?
The update written by the CanChild Centre referred to above, provides an excellent overview of CIMT, as well as a review of the research.

Parents, if you think your child could benefit from constraint induced movement therapy, ask your pediatrician, your child's physical or occupational therapist, or check with your local children's hospital to see if they offer a program.

Therapists, Cincinnati Children's Hospital has created an Evidence-Based Care Guideline for Pediatric Constraint Induced Movement Therapy. To download the guidelines, visit their website by clicking here. Scroll to the bottom of the page and click on Constraint-Induced Movement Therapy under the Occupational Therapy and Physical Therapy section.


Check back tomorrow to learn about technique that I use to promote the use of a child's affected arm.