Constraint induced movement therapy

Just a good idea

Fashion is important in physiotherapy. As any fashion trend it keeps on changing. When I attended college, the field of stroke rehabilitation featured various approaches, including Bobath, PNF, and the Brunnstrom method, which my principal physiatrist favored. They were written in 50s and 60s. Even though we hardly understood of these techniques, their underlying principles, and the associated physiology was limited, it was the fade. Even today some use them- not as a costume but as a dress to go out.

Newer trends:

Commencing with influential figures such as Janet, Roberta, and Antoinette Gentile, the journey culminated in the STEP II conference, marking the advent of a new era centered around function-based movements. This trend, a modest improvement in fashion—considering the questionable appeal of bell bottoms worn by one's father or grandfather in the 60s and 70s—is one I hitched my wagon to and continue to ride.

The science behind functional movement-based therapies has advanced, supported by a growing body of research substantiating their effectiveness. While many have come to appreciate their value, some educators and university curricula remain entrenched in outdated practices akin to bell bottoms.

Bedazzling of functional movements:

When a method proves effective, it's essential to refine it for improvement. People started exploring numerous forms of functional movement therapies, incorporating extravagant tools such as unweighing treadmill gait therapy and virtual reality (given the costly nature of reality itself). Regrettably, these expensive devices often seem designed more to showcase the size of one's grant,( you know what Freud said about size) rather than serving the greater good of the community. Effectiveness of these interventions is also poor.

One of the better mouse traps which was built was constraint induced movement therapy (CIMT). It had the right ingredients a combination of functional activity and behavioural modification techniques. Unlike other methods of treatment, this one caught the attention of everyone. You know it was a huge fade, when it is a important question for masters exams and you open any guidelines for stroke- bam there it is- do CIMT.

CIMT- why it is not good treatment:

My infatuation with CIMT was short lived. After attempting it on two or three patients, I eventually abandoned the approach. The process was laborious, and even practicing for just half an hour posed a challenge, let alone the 3 to 6 hours of intensive practice required for CIMT. The experience was dull, my patients were frustrated, and we never completed the full four weeks of practice with any individual.
Well, my experience aside, when you look the evidence, it has shown to be wanting. I am also sure no one in any hospital were more than 1 patients attend the OPD, you can do CIMT. In essence, CIMT can be likened to a fashion show seen on TV—appealing, no one can wear other than the anaemic coat hangers who walk on the runway.

But why do all guidelines and teachers have a infatuation with it?

Perhaps there's an inherent drive to discover a singular, miraculous treatment for upper limb rehabilitation—a sort of holy grail in our field. Our preoccupation with recovery over rehabilitation could also contribute to this fascination, but i don’t know. It's essential to recognize that neuroplasticity has its limits, often more constrained than we commonly assume. In non-pharmacological treatments, the benefits are typically modest, if not small. It might be time to shift our focus on fashion which are wearable.

Let’s bury CIMT along with all the therapies from 60s like Bobath, PNF and others and think afresh.