Constraint-Induced Therapy (CIT)

This is part of our on-going series of exploring neurological and degenerative conditions that can affect a number of individuals and specifically how Physical Therapy can help”

Today’s topic is Constraint Induced Therapy (CIT) which is an excellent topic for the last few weeks of discussing neuroplasticity.  CIT is a pretty main stream tool of enhancing the neuroplastic process, improving motor re-learning and function especially with the hand and arm.  CIT can be particularly helpful for individuals who have suffered great functional loss in their hand and arm movements whether from a stroke, brain injury, spinal cord injury or multiple sclerosis relapse.

The basic approach of CIT is that the unaffected hand and arm are immobilized via a sling, mitt or sometimes in kids the unaffected hand is put in a cast.   The unaffected arm stays in the immobilizing apparatus for 6-8 hours and sometimes even longer than that while the affected arm performs certain tasks and a lot of repetitive practice.  There are many modifications to the CIT protocol and is based on the individuals needs and sometimes theory of the clinic.

Research indicates that in order for CIT to work and be effective there needs to be some active movement in the hand.  An individual has to display the ability to actively lift hand, thumb and at least two fingers from a relaxed position.  Demonstrate The ability to release the ability  release a grasped tennis ball.  The ability to pick up and release a rag off a tabletop with any type of grasp and release method. In some cases a standard of just being able to wipe a towel across the table.  Once an individual qualifies for this treatment, the treatment is best executed and instructed by an occupational or physical therapist in order to ensure safety and effectiveness.

By using this technique it can help with learned non-use where the affected arm learns to do nothing because the unaffected arm does everything since it requires less effort and frustration.   The keys are repetitive practice and lots of it.  CIT is primarily used and more effective in the arm/hand rather than in the leg.  There is some research for use with in the leg but most evidence is in regards to the arm and wrist.

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