In The Name Of Allah The Most Beneficent And Most Merciful

Sports Clinic & Physiotherapy Centre

By Shahid Ahmed Heera www.sportsclinic.com.pk

Sports Clinic & Physiotherapy Centre

CIMT & Neuro Rehabilitation

Sports Clinic & Physiotherapy Centre

Objectives:
To Discuss The Latest Physical Therapy Approaches Used In
Neuro-rehabilitation.

To Understand the Effect Of CIMT (Constraints Induced

Movement Therapy) In Stroke Patients.

Sports Clinic & Physiotherapy Centre

Commonly Used Physiotherapy Treatment Approaches

Movement Therapy. (Brunnstrom) Proprioceptive Neuro-muscular Facilitation . (Kabat)

Motor Relearning Theory. (Car and Shepherd)

Neuro-Developmental Treatment. (Bobath) Rood Approach. (Roods)

Sports Clinic & Physiotherapy Centre

Current Treatment

Approaches
Rehabilitation approaches are based on Theories of Motor Learning. These includes RIMT

Robotic Interactive Movement Therapy

Biofeedback

EMG-Triggered Neuromuscular. Stimulation.

CIMT

Constraint-induced Movement Therapy

Sports Clinic & Physiotherapy Centre

Robotic therapy in stroke patients

Robots can perform a wide range of threedimensional movements. They are accurate, powerful, and compliant, and they can perform many of the highly repetitive tasks required of physiotherapists. Robot-assisted UL rehabilitation can reduce UL impairment and improve motor control in patients with severe UL paresis from chronic stroke.

Sports Clinic & Physiotherapy Centre

Neuromuscular Electric Stimulation

The Neuromuscular Electric Stimulation (NMES) on motor recovery and gait kinematics of patients with stroke will improve the motor control.
The Researches concluded that NMES combined with a conventional stroke rehabilitation program in terms of lowerextremity motor recovery and gait kinematics improves the functional activity.
Sports Clinic & Physiotherapy Centre

Constraint Induced Movement Therapy (CIMT)

Sports Clinic & Physiotherapy Centre

CONCEPT
To improve functional (meaningful) use of an impaired limb through the systemic application of shaping and repetitive use strategies without employing the contra lateral limb over a defined time interval
Sports Clinic & Physiotherapy Centre

Our Behaviors Affect Our Brain As Much As Our Brain Affects Our Behaviors

Sports Clinic & Physiotherapy Centre

If you don't use it ,you loose it

Learned non-use of the hemiplegic arm is thought to occur as a result of the deficits in the individuals arm. For instance, a right handed individual who has sustained a stroke may become more dependent upon others for their activities of daily living or adapts to their right sided weakness by using their left hand.
Sports Clinic & Physiotherapy Centre

Constraint Induced Movement Therapy (CIMT)

Constraint Induced Movement Therapy (CIMT) is an intervention that assists individuals in increasing the functional use of their hemiplegic arm.
CIMT involves constraining the non-affected arm which forces the participant to use the hemiplegic arm while participating in selective activities. A number of Neuro-imaging studies have shown that the massed practice of CI Therapy produces a massive use-dependent cortical reorganization that increases the area of cortex involved in the innervation of movement of the more-affected limb.
Sports Clinic & Physiotherapy Centre

Implementing Constraint Therapy

Patients must be at least six months post stroke, have decreased ability to use their arm, have caregiver support and be medically and behaviorally stable. Patients must be able to attend the program three times a week for 5 hours a day. Patients will need to wear a restraining device on their non-affected limb during therapy sessions as well as at home Therapy will last six hours a day, five days a week, for three weeks.
Sports Clinic & Physiotherapy Centre

Implementing Constraint Therapy

Physician orders cast Orthotist below elbow, extends 1-2 cm distal to fingertips all joints placed in neutral thumb and fingers are enclosed casted for 3 wks or 14 days intermittently
Sports Clinic & Physiotherapy Centre

PATIENT INCLUSION CRITERIA

Minimal motor criteria higher and lower functioning Willingness to participate signed informed consent Not excluded if have somatosensory deficit Any type of previous rehab interventions

Sports Clinic & Physiotherapy Centre

EXCLUSION CRITERIA
Under the age of 18 Terminal illnesses Intent to move or relocate too far away Ongoing pharmacological therapy Intended pharmacologic therapy Not meet minimal motor criteria Extreme aphasia or mental incompetence
Sports Clinic & Physiotherapy Centre

TRAINING
2 weeks training and up to 6 hours per day Repetitive task practice Shaping Home exercise concurrent ten days of intensive exercise of the affected upper limb for four hours daily
Sports Clinic & Physiotherapy Centre

Tasks included
Quoits, peg boards, cards, puzzles, stacking blocks, jigsaws and dominos. Each task was progressed by making the participants reach further or faster, or by using smaller pieces. Prior to intervention two pre-treatment measurement sessions were undertaken to provide a baseline measure of upper limb ability for each participant. Two post-treatment measurement sessions were undertaken at one week and three months after the intervention.
The exercises were based on a battery of tasks developed by Taub (2001, unpublished information) and outlined in previous research (Morris et al. 1997, Taub et al. 1994). Sports Clinic & Physiotherapy Centre

EVALUATION

Pre intervention Post intervention Every 4 months for 2 years Delayed group receives treatment during second year

Sports Clinic & Physiotherapy Centre

The intervention in a physiotherapy gymnasium

Physiotherapist and physiotherapy assistant to approximate the level of supervision typically able to be provided in an outpatient setting. Each participant had a daily schedule of 10 exercises to undertake, with two breaks during the four and a half hour programmed. A schedule of exercise tasks was briefly trialled to select appropriate tasks for each participant.

Sports Clinic & Physiotherapy Centre

Types of CONSTRAINTS
sling Splint Socks

Sports Clinic & Physiotherapy Centre

What Patients will be able to do..

use the mouse for the computer. eat using RT hand. pick up the phone with the weaker hand. hold a cup. carry things. use the hand to help do buttons. tie shoelaces and do zippers.

Sports Clinic & Physiotherapy Centre

Outcome Measures
The following measures were selected as primary outcomes to assess upper limb impairment and function: The Fugl-Meyer Assessment (FM) upper extremity) The Motor Assessment Scale (MAS) The Nine-Hole Peg Test

Sports Clinic & Physiotherapy Centre

Secondary outcome measures included

The Modified Ashworth Scale to assess muscle tone of elbow Flexors. The MAL

Sports Clinic & Physiotherapy Centre

Sports Clinic & Physiotherapy Centre

Sports Clinic & Physiotherapy Centre

ADD LIFE TO YEARS NOT YEARS TO LIFE

Sports Clinic & Physiotherapy Centre

Sports Clinic & Physiotherapy Centre

Thank You

Sports Clinic & Physiotherapy Centre