CI Therapy is the learned usefulness of the weaker arm and hand
Services
What is Constraint Induced Movement therapy?
Dr Taub said, Constraint Induced Movement therapy was too much of a mouth full to say, so he shortened it to CIMT or CI Therapy. CI Therapy is an intensive rehabilitation program which has been proven to increase functional use of the upper limb following brain injury, in certain people. Increased movement means the ability to engage in more meaningful activities and social settings, giving people greater independence and a better quality of life.
CI Therapy is based upon the ground-breaking research of Edward Taub PhD. (Behavioural Neuroscientist) and the CI Therapy Research Group at the University of Birmingham, Alabama, USA. There has been sufficient evidence to promote the use of CI Therapy following stroke since 1986. Since then numerous randomised controlled trials have demonstrated CI Therapy can be useful in the treatment of upper limb retraining in cerebral palsy, multiple sclerosis, traumatic and acquired brain injury. For more information see FAQ below.
What makes CI therapy so effective?
Many rehabilitation programs do not allow the brain enough time and exercise to re-wire itself, called neuroplasticity. CI Therapy combines the best techniques currently available in upper limb rehabilitation.
Dr Taub’s research has shown that CI Therapy works in two ways: it overcomes learned “non-use” and enables neuroplasticity in the brain.
- “Learned non-use, “is the automatic and protective behaviours someone adopts after a major brain trauma; using the weaker arm less and the stronger arm more.
- Neuroplasticity simply means “changing the brain”. This is where the areas next to the damaged brain learn and take over the movements lost through the injury. In other words, CI Therapy “re-wires” the brain, permanently.
Why such an intensive program?
Most CI Therapy programs run for 2-3 hours a day, 5 days a week for 2-3 weeks. The intensity depends upon a participant’s level of disability, fatigue, goals for therapy and whether they have a support person available. Research has shown that it is the intensive nature of the program which re-wires the brain and there is no need for ongoing therapy. We may check in with you a year or two after your program for “top-up” therapy, but research demonstrates that gains made are retained for 2 years.
CI Therapy usually takes place for 2 hours each day, if the client is able to perform 1 hr of self-directed therapy, or has a support person who can help. Otherwise we recommend 3 hrs of therapy. Additionally, a mitt is worn for 6hrs a day, enabling the functional use of the more affected hand. Our home-based program ensures that progress continues without a therapist present.
Frequently Asked Questions
Perhaps you have been wondering?
CI Therapy is not for everyone, which is why we need to assess you before committing to commence therapy. While we would love to help everyone, some people may be excluded due to the severity of their brain injury:
- Function: the person receiving CI Therapy needs to have some movement in the upper limb: a minimum of 20º wrist extension and 10º finger extension.
- Mobility: the person can ideally mobilise independently with an aid and be able to attend to all their own toileting needs.
- Cognition: the person has sufficient cognition to follow through with a one-hour home-based therapy program independently or have a carer present.
- Communication: the person can answer a series of yes/no questions reliably.
- Pain: the person does not experience levels of pain anywhere in their body which could interfere with the demands of an intensive therapy program.
Why CI Therapy is not considered restrictive practice:
Participants are encouraged to wear a therapy mitt on their stronger hand, which looks like an oven glove without a thumb. This helps the person focus on the function of their weaker hand, while giving the stronger one a holiday. It helps prevent unconscious habits and unintentional reaching with the stronger hand, while practicing fine motor tasks with the weaker one. The person is easily able to remove the mitt themselves, at any time. In fact, therapy can be just as successful without a mitt, it is merely to remind the person to use their weaker hand.
NDIS and Mechanical Restraint
“Mechanical restraint is the use of a device to prevent, restrict, or subdue a person’s movement for the primary purpose of influencing a person’s behaviour but does not include the use of devices for therapeutic or non-behavioural purposes.”
See: www.ndiscomission.gov.au
It costs between $3975 – $6795, depending upon a number of different factors:
- How many hours of therapy is required (minimum 20hrs.)
- If therapy is needed over a two or three week period?
- If you have a support person or can do additional therapy tasks on your own.
- The distance we need to travel to get to you.
If you or your doctor feel CI Therapy may be of benefit to you or an adult family member, please contact us to discuss how we can help. We will assess your situation over the phone and then in person, before enrolling you in the 2-3 week program. This program is run as a private service, however there are a number of options to help you pay:
- Private Health Insurance: Depending on your “Extra’s Cover,” if Occupational Therapy is included, they may pay between $200-$400 per person / policy per year. Please contact your private health fund to find out how much you can claim.
- Medicare: Only under the Extended Medicare Safety Net you may receive a benefit, but the bulk of the cost will be incurred privately.
- Department of Veteran Affairs: May reimburse Gold card holders for allied health medical expenses privately incurred, as long as you do not also claim Medicare or Private Health Insurance too. Please check with them first to avoid disappointment.
- National Disability Insurance Scheme: For Self-Managed and Plan Managed clients, please ensure your Support Co-Ordinator has approved a budget for CI Therapy of 20-30hrs total of Occupational Therapy. Please note that Agency managed participants cannot access funding with us as I am not currently registered with NDIS, however this may change in the future.
- I-Care – Lifetime Care and Support: prior approval is required to access funding, so talk to your coordinator / case manager first.
CI Therapy has been tested at the highest levels and has a significant body of scientific evidence supporting its use with people who have been diagnosed with stroke. Randomised Controlled Trials for traumatic brain injury / acquired brain injury, cerebral palsy and multiple sclerosis are ongoing.
Stroke 1: https://jamanetwork.com/journals/jama/article-abstract/203876
Stroke 2: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4361809/
How long do the benefits last? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2329576/
Traumatic Brain Injury: http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.611.847&rep=rep1&type=pdf
Cerebral Palsy in children: https://www.sciencedirect.com/science/article/pii/S1836955316300169
Multiple Sclerosis 1: https://journals.sagepub.com/doi/full/10.1177/1545968318761050
Multiple Sclerosis 2: https://journals.sagepub.com/doi/full/10.1177/1545968317753073
Yes, if you look at the Australian Clinical Guidelines for Stroke Management: Chapter 5, Rehabilitation, Arm Activity:
Strong Recommendation: “For stroke survivors with some active wrist and finger extension, intensive constraint-induced movement therapy (minimum 2 hours of active therapy per day for 2 weeks, plus restraint for at least 6 hours a day) should be provided to improve arm and hand use.” (Corbetta et al. 2015)
See: https://app.magicapp.org/#/guideline/Kj2R8j/section/nyGJPj
There are other upper limb therapies which may help you, if your brain injury has been extremely severe. We are happy to discuss other options or recommend other therapies or therapists to help you.
This privacy policy sets out how we use and protect any information that you give us when you use this website.
We are committed to ensuring that your privacy is protected. Should we ask you to provide certain information by which you can be identified when using this website, then you can be assured that it will only be used in accordance with this privacy statement.
What we collect
We may collect the following information:
- name
- contact information including email address
- medical information and history
- demographic information
What we do with the information we gather
We require this information to understand your needs and provide you with a better service, and in particular for the following reason:
- We use your information to contact you to follow up with enquires or book an appointment. We may contact you by email, phone or mail.
Security
We are committed to ensuring that your information is secure. In order to prevent unauthorised access or disclosure, we have put in place suitable physical, electronic and managerial procedures to safeguard and secure the information we collect online.
Links to other websites
Our website may contain links to other websites of interest. However, once you have used these links to leave our site, you should note that we do not have any control over that other website. Therefore, we cannot be responsible for the protection and privacy of any information which you provide whilst visiting such sites and such sites are not governed by this privacy statement. You should exercise caution and look at the privacy statement applicable to the website in question.
Controlling your personal information
We will not sell, distribute or lease your personal information to third parties unless we are required by law to do so.
If you believe that any information we are holding on you is incorrect or incomplete, please write to us or email us as soon as possible. We will promptly correct any information found to be incorrect.