Natalie Wright reflects on introducing a CIMT programme to a community occupational therapy service .
Supporting people to meet their rehab goals
Natalie Wright reflects on introducing a CIMT programme to a community occupational therapy service .
C onstraint Induced Movement Therapy ( CIMT ) is based on research by Dr Edward Taub and collaborators at the University of Alabama ( Taub et al 2009 ).
They describe the ‘ learned non-use ’ phenomenon as a behavioural adaptation that occurs in response to the loss of sensory feedback , due to a decrease in co-ordinated movements , negative reinforcement from unsuccessful attempts with the impaired limb , and positive reinforcement resulting from success in compensatory movement patterns with the unimpaired limb . The result of this is a decrease in functional use of the impaired upper limb .
It has good evidence for use in inpatient settings with various neurological client groups and although there is a modified mCIMT version , it does not appear to be widely used in community settings .
On examining available research for this , this appeared to be predominantly due to lack of clinician knowledge and confidence in its application . Moreover , mCIMT studies often fail to provide a detailed standardised description of the protocol applied and is subject to clinician discretion . The protocol principles generally are repetitive training and the constraining element .
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Introducing CIMT to our community setting
While considering the use of this in our community team , I had to think how practical its application would be and come up with a reasonable programme that could be applied for suitable patients .
I was signposted to a specialist occupational therapist , Kathryn Jarvis , who has extensive research experience of CIMT . She was able to provide me with summaries and protocols of her research , which helped me to tailor a programme for mCIMT in the community
46 OTnews June 2023