Rehabilitation
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 .”
© gece33 via Getty Images
Rehabilitation
Feature
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 .”
© blackCAT via Getty Images and to consider the inclusion criteria and outcome measures to be used .
I also met with an advanced specialist occupational therapist , Alison Murray – who at that time was providing inpatient traditional CIMT – and other colleagues , to share resources and discuss its application and considerations .
I was able to utilise and adapt resources for my current service , particularly in terms of consent , measurement recording and the behavioural contract .
A behavioural contract is recommended so that clients are aware they can withdraw at any time and to ensure family / carers are prepared for the level of support that may be required .
Shaping a programme
Traditional CIMT is rigorous and strict – with the wearer often completing this seven hours daily for two weeks . It is largely unsupervised , but as it is completed in hospital settings , there is a degree of support / evaluation available .
It comprises a variety of tasks such as ‘ shaping ’ ( these are small and easily graded repetitive tasks aimed at motor relearning ) and functional tasks , with the client wearing a mitt on the unaffected hand to prevent this from being used . Activities are tailored to each client to be client centred and meaningful .
The consensus for the modified mCIMT is three to five hours of mitt wear , over a longer duration ; two to four weeks , but it can be for up to 10 weeks . This is non-standardised and is open for negotiation between therapist and client , dependant on what suits their level and any other factors to consider .
Within the community setting , I opted for two to three weeks of mCIMT at three hours a day ; either a total morning or an afternoon . This was unsupervised , but the client received assistance for set up on the first day and a mid-way evaluation to monitor compliance / progress and to grade tasks as needed .
Inclusion criteria for CIMT is often strict and , after discussion with Kathryn , I felt that this may restrict a lot of our patients who have less available range of movement . It was felt that tasks to include proximal function may help to develop distal activity and help to address more gross motor functional tasks ; therefore , assessing eligibility via traditional digit extension may not be the most appropriate .
So , I opted to exclude this within our setting . It was felt that if the client could pick up a cloth and release – regardless of movement patterning – this was sufficient . This again is open to negotiation and at the discretion of the clinician , as although parameters for inclusion are suggested by Dr Taub , they are not standardised .
With standard CIMT , often baseline range of movement is measured . I elected not to take pre-mCIMT measurements because our inclusion criteria was lower level , and often ROM measurements do not equate to a client ’ s functional ability .
It was felt that in the community it was less appropriate to spend time doing measurements and get straight into the functional occupational therapy tasks and function-based outcome measures that translate more into real life ; the true essence of what we do in occupational therapy .
Considerations for exclusions remained as per traditional CIMT ,
June 2023 OTnews 47