Saturday, January 31, 2015

The [CIMT] Challenge

Pamela Hsieh
Rehab Revolution
16 April 2010

CIMT. Constraint-Induced Movement Therapy. This is a therapy technique in which a glove, mitt, or any kind of constraint is used to cover the unaffected hand at all times, which requires the forced use of affected hand. This should be done in conjunction with regular occupational therapy, which in theory should compensate for the inevitable poor form that will result from the forced use. It's also traditionally done with supervision, which makes it an even more challenging process, especially when you're by yourself.

Recently here in Chicagoland, an occupational therapist specializing in CIMT began a research project on modified CIMT practice. In this study, she had roughly twenty volunteer patients do CIMT for six hours per day for two weeks (I believe this to be called mCIMT, for modified). There is an activity log to fill out and a motor test right before and right after the program to test for results.

The CIMT program is promising because it forces your healing practice both by inducing your weaker side's movement and increasing your awareness of it (something that really fades over time), and by making you accountable to others. It's still a system in progress, and I've got a lot of feedback from the first time and current trial --

tips//additional observations
  • you don't necessarily have to wear the mitt during the six hours; when performing a dual-handed activity it helps to put the mitt somewhere visible as a gentle reminder to use your affected hand.
  • you've got to catch yourself "cheating" and consciously push yourself not to. For instance, when folding laundry, fold primarily "affected to unaffected" instead of the more natural reverse.
  • find someone to check in with, someone else who will ask you about your progress, because motivation easily ebbs and flows. Having a buddy will help counteract the ebb.
  • it's also possible to go an entire day "wearing the mitt" but not doing anything. If you're going to bum around for twelve hours in front of the TV, make sure you take some time out to do hand or arm exercises so you're doing something.

  • the forced use drastically increases your immediate memory of your affected hand -- this helps you form better habits -- remember, use it or lose it!
  • having a log is a good way to track your progress, after which you should be sure to reward yourself!
  • eventually you become so accustomed to doing something with both hands that it feels strange to you to ever go back to doing it one-handedly. In my experience, this is what happens with typing, since I type so much every day.

  • since you're on your own, it's easy to forget (and six hours is a long time). Push yourself and don't let the typical excuses get in the way. Your rehab revolution starts with you.
  • you'll never do it when you're in a hurry.
  • wearing that mitt outside of the home setting is, at least for me, too embarrassing, so for that, I have to rely on conscious reminders. (Even at home or around friends, you will get a lot of questions, believe me.)
  • If you don't ask someone to push you, even a friend or family member who knows you're doing it won't automatically give you verbal reminders. So make sure you ask them to. Or, carry the mitt around with you if you're more like me and rarely actually wear it.
I first participated in the CIMT study in February 2010. I've decided to restart another bout of two weeks on 7 April (the real birthdate of Rehab Revolution!), so the end date is the twenty-second. Please refer to the new experiments page for the results of this new challenge.

Activities for today. Here goes:
  • dressing
  • washing face (something I promised myself to do both-handedly at least once a day, every day, months ago)
  • bathing
  • cooking/food preparation (peeling sweet potatoes!)
  • Theraband exercises, including wrist movements
  • arm and shoulder exercises (biceps, triceps, retraction, protraction)
  • extensive typing (posting, e-mailing, messaging)
  • laying out laundry on drying rack
I'll keep you all posted. In the meantime, I'll also get some more info up on the other healing methods I'm exploring and learning about. Wish me luck!

To our healing,

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