Sachdev H.S.1
1All India Institute of Medical Sciences, Neurology, New Delhi, India
Background: CIMT has been a popular upper extremity rehabilitation intervention in stroke subjects. Clinical and practical factors in implementation restrict its applicability in regular practice. r-CIMT is based on the current limitations that could widen the applicability and usability of CIMT concept.
Purpose: The theoretical model and concept is based on scientific researches and clinical problems faced in stroke therapy settings. Reverse CIMT will reduce the development of maladaptive motor pattern, nonfunctional synergies, and secondary complications in stroke subjects. The intervention would focus on task based, functional training of the affected upper extremity in acute stoke subjects.
Methods: Based on the current literature of CIMT and modified CIMT, a model of r-CIMT was theoretically conceptualised and a management model designed. The intervention would focus on subjects with unilateral hemiparesis due to stroke. the subjects will be made to wear the constraint on the affected upper extremity, instead of the unaffected extremity as in traditional CIMT and m-CIMT. This would restrict any attempt to move the arm in presence of weaknes, thus reducing the unwanted effort to move, which is responsible for compensatory patterns and maladaptive synergies. The affected arm of the subject would be unconstrained and trained based on task oriented and functional training models for a minimum of 6 hours per day (training phase) for 2 weeks. During the non training phase of 10 hours hours per day (constrained affected Upper extremity) the unaffected arm will be kept at a behavioral disadvantage by a weighted cuff (2% of body weight) tied at the wrist alongwith a hand glove restricting afferent inputs. In our view, the therapy would enhance the training effects by reducing errors, and unwanted movements of the affected upper extremity while allowing task oriented and functional training in selected tasks for 6 hours per day.
Results: Theoretical Model based study.
Conclusion(s): The r-CIMT could be an intervention leading to reduction in rehabilitaion duration, preventing development of maladaptive, non-functional, compensatory movement patterns early after stroke.
Implications: Revention of new and non functional movement compensations are difficult to unlearn, which usually restricts potential for recovery of function in the long term. Training based on task oriented and functional models will assist the wanted patterns of movement to be reinforced and be learnt.
the acute stroke subjects were selected, to prevent any experience of unwanted effort and undue straining at attempts to move, and may also prime the CNS for later attempts at movement based training.
Funding acknowledgements: Not Applicable
Topic: Neurology: stroke
Ethics approval: Theory based concept, hence ethics approval not required.
All authors, affiliations and abstracts have been published as submitted.
