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About TeleCIMT for Therapists

What is TeleCIMT?

Constraint-Induced Movement Therapy (CIMT) is a well-evidenced approach to improve strength and function in a patient's weaker upper limb after a neurological event. TeleCIMT is a three-week home-based CIMT program developed by the TeleCIMT International Development group (TIDE), an international group of therapists experienced in CIMT.

TeleCIMT is designed to be delivered via Telehealth and was developed in response to the increasing need across the world to provide therapy from a distance. TeleCIMT can also be used in any health care setting which uses Telehealth as a mode of rehabilitation delivery e.g. for populations who live in remote areas where face to face contact is difficult.

TeleCIMT can be run 100% remotely, or with a mixture of face-to-face and remote contact between therapist, participant and their supporter.

Is TeleCIMT suitable for my patient/client?

If your patient has learned to depend on their stronger arm in everyday life and has potential to improve the strength and function of their weaker arm, then they could be appropriate. There are clear guidelines on whether a patient is appropriate for a CIMT or TeleCIMT program. The main guide is that the patient should be able to pick up AND release a washcloth onto a table at least three times in one minute. Use the screen form to further determine if your patient is appropriate.

All participants will need access to a device for making video calls throughout the three-week program. We recommend participants use a laptop as opposed to a phone and most participants will also require a named supporter with them to assist with video therapy.

How does a TeleCIMT program run?

The program runs five days a week for three weeks with mitt-wearing for six hours a day to restrict the use of the participant's stronger arm. Click here for an example of a therapist TeleCIMT timeline.

During this time, your patient will need to work intensively on chosen activities which tackle the specific movement problems you identify together via assessment. They will also follow an agreed schedule of routine daily activities they will use their weaker arm for to transfer skills learned into daily life use.

The program requires commitment from the therapist, participant and their supporter, but the concentrated hard work put in over just three weeks will give the best chance of improving the participant’s arm use and the confidence they have in their abilities.

How can I learn more about implementing a TeleCIMT program for my patients?

To learn how to run an effective TeleCIMT program with your patients, no prior CIMT experience is required. However, we strongly recommend you first work through the therapist learning resources. You will be directed to review the TeleCIMT paperwork (TeleCIMT therapist resources) and then work through the TeleCIMT video learning modules. If you already have sound CIMT knowledge and experience, you can skip to the TeleCIMT-focused video training to save time, after reviewing the TeleCIMT paperwork.

The TeleCIMT resources are free to download from this website and include educational videos, step-by-step practice booklets, CIMT specific exercise libraries and all the therapist paperwork required to conduct a TeleCIMT program from screening to completion.

The idea behind creating a thorough set of resources is to provide sound CIMT implementation support for therapists. By doing so, we hope to enable therapists with all levels of experience to learn about CIMT and, using the resources created, be able to deliver CIMT more routinely in practice.

About the TeleCIMT TIDE Group

These free resources have been developed by the TIDE (TeleCIMT International DEvelopment) Group of occupational therapists and physiotherapists to help participants and therapists prepare for and conduct a remote three-week TeleCIMT program.

When the Covid-19 lockdown first hit the UK in March 2020, the TIDE group came together to develop resources to support the delivery of CIMT remotely. The aim was to enable the provision of intensive home-based arm therapy, despite worldwide social restrictions.

Since the start of the Covid-19 pandemic in March 2020, all TIDE Group members have worked voluntarily in their own time to develop these TeleCIMT resources. Each team member has made significant intellectual contributions to the design, revision and editing of all resources on this website. Collectively, they have shared a significant amount of clinical and educational CIMT resource materials and developed these for use in TeleCIMT.

JESSAMY BOYDELL - Lead Resource Developer & Specialist Neurological Occupational Therapist
DR LAUREN CHRISTIE - PhD, Occupational Therapist and Senior Implementation Science Research Fellow - Allied Health
ANNIE MEHARG - Specialist Neurological Physiotherapist
ANNA KILKENNY - Neurological Physiotherapist

Acknowledgements & Supporting Evidence

The following therapists provided valuable information and/or feedback on program content, and generously shared their resources/knowledge:

Dr Annie McCluskey, Honorary Senior Lecturer, Discipline of Occupational Therapy, The University of Sydney & The StrokeEd Collaboration, Sydney, Australia.
Dr Sarah Blanton, Associate Professor, Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, Atlanta, Georgia, United States of America.
Dr Arlette Doussoulin, Assistant Professor, Pediatric and Surgery, University de La Frontera, Temuco, Chile
Dr Praveen Kumar, Senior Lecturer, Physiotherapy, University of West England, Bristol, United Kingdom.
Jill Kings, Occupational Therapist, Clinical Director, Neural Pathways, Gateshead, United Kingdom.
Dr Jill Whitall, PhD, FNAK, Professor Emerita, University of Maryland School of Medicine, Department of Physical Therapy & Rehabilitation Science, USA.

The following occupational therapy candidates at Australian Catholic University provided valuable contribution to the development of written and video resources:

Iris Ly
Brigitte Mcintosh
Elizabeth Shaw
Jacqueline Cavalletto

We also thank the CIMT participants and their supporters who have allowed their photos to be used for our project and who provided valuable feedback on program content and resource development. We acknowledge the pioneering work of Dr Edward Taub and his team at the University of Alabama at Birmingham, in developing the concept of CIMT.

References & Useful Literature

Practical Guide for CIMT:

Meharg, A. and Kings, J. (2015). How to do Constraint-Induced Movement Therapy: A practical guide. United Kingdom, Harrison Training. Accessible from: https://www.harrisontraining.co.uk/

Clinical Guidelines for Stroke Management:

https://informme.org.au/en/Guidelines/Clinical-Guidelines-for-Stroke-Management

Protocol Paper for the ReCITE study on TeleCIMT:

Christie LJ, Fearn N, McCluskey A, Lannin NA, Shiner CT, Kilkenny A, Boydell J, Meharg A, Howes E, Churilov L, Faux S, Doussoulin A, Middleton S. (2022). Remote constraint induced therapy of the upper extremity (ReCITE): A feasibility study protocol. Frontiers in Neurology.13 https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2022.1010449/full

Systematic reviews of CIMT:

Kwakkel, G., Veerbeek, J. M., van Wegen, E. E., & Wolf, S. L. (2015). Constraint-induced movement therapy after stroke. Lancet Neurology, 14(2), 224-234. doi:10.1016/S1474-4422(14)70160-7.

Corbetta, D., Sirtori, V., Castellini, G., Mjoa, L., & Gatti, R. (2015). Constraint-induced movement therapy for upper extremities in people with stroke. Cochrane Database of Systematic Reviews (10). doi:10.1002/14651858.CD004433.pub3

Fleet, A., Page, S. J., MacKay-Lyons, M., & Boe, S. G. (2014). Modified constraint-induced movement therapy for upper extremity recovery post stroke: what is the evidence? Topics in Stroke Rehabilitation, 21(4), 319-331. doi:10.1310/tsr2104-319.

Comparison of CIMT to other dose matched interventions:

Stevenson, T., Thalman, L., Christie, H., & Poluha, W. (2012). Constraint-Induced Movement Therapy Compared to Dose-Matched Interventions for Upper-Limb Dysfunction in Adult Survivors of Stroke: A Systematic Review with Meta-analysis. Physiotherapy Canada, 64(4), 397-413. doi:10.3138/ptc.2011-24.

Papers describing the CIMT protocol and it’s components:

Morris, D., Taub, E., & Mark, V. W. (2006). Constraint-induced movement therapy: characterising the intervention protocol. Europa Medicophysica, 42(3), 257-268.

Taub, E., & Morris, D. M. (2001). Constraint-induced movement therapy to enhance recovery after stroke. Current Atherosclerosis Reports, 3(4), 279-286. doi.org/10.1007/s11883-001-0020-0.

Key clinical trials (CIMT delivered face to face):

Wolf, S. L., Thompson, P. A., Winstein, C. J., Miller, J. P., Blanton, S. R., Nichols-Larsen, D. S., . . . Sawaki, L. (2010). The EXCITE stroke trial: comparing early and delayed constraint-induced movement therapy. Stroke, 41(10), 2309-2315. doi:10.1161/STROKEAHA.110.588723.

Wolf, S. L., Winstein, C. J., Miller, J. P., Taub, E., Uswatte, G., Morris, D., . . . Investigators, E. (2006). Effect of constraint-induced movement therapy on upper extremity function 3 to 9 months after stroke: the EXCITE randomized clinical trial. JAMA, 296(17), 2095-2104. doi:https://dx.doi.org/10.1001/jama.296.17.2095.

Lin, K., Wu, C., Liu, J., Chen, Y., & Hsu, C. (2009). Constraint-induced therapy versus dose-matched control intervention to improve motor ability, basic/extended daily functions, and quality of life in stroke. Neurorehabilitation and Neural Repair, 23(2). doi:10.1177/1545968308320642.

Lin, K., Wu, C., Wei, T., Lee, C., & Liu, J. (2007). Effects of modified constraint-induced movement therapy on reach-to-grasp movements and functional performance after chronic stroke: a randomized controlled study. Clinical Rehabilitation, 21(12), 1075-1086. doi: 10.1177/0269215507079843.

Doussoulin, A., Rivas, C., Rivas, R., & Saiz, J. (2018). Effects of modified constraint-induced movement therapy in the recovery of upper extremity function affected by a stroke: a single-blind randomized parallel trial-comparing group versus individual intervention. International Journal of Rehabilitation Research, 41(1), 35-40. doi:10.1097/mrr.0000000000000257.

Thrane, G., Askim, T., Stock, R., Indredavik, B., Gjone, R., Erichsen, A., & Anke, A. (2015). Efficacy of Constraint-Induced Movement Therapy in Early Stroke Rehabilitation: A Randomized Controlled Multisite Trial. Neurorehabilitation and Neural Repair. doi:10.1177/1545968314558599.

Kwakkel, G., Winters, C., van Wegen, E., Nijland, R., van Kuijk, A., Visser-Meily, A., . . . Meskers, C. (2016). Effects of unilateral upper limb training in two distinct prognostic groups early after stroke: The EXPLICIT-Stroke randomized clinical trial. Neurorehabilitation and Neural Repair, 30(9), 804-816. doi.org/10.1177/1545968315624784.

Papers exploring mitt wear component:

Uswatte, G., Taub, E., Morris, D., Barman, J., & Crago, J. (2006). Contribution of the shaping and restraint components of Constraint-Induced Movement Therapy to treatment outcome. NeuroRehabilitation, 21(2), 147-156.

Brogårdh, C., & Lexell, J. (2010). A 1-year follow-up after shortened constraint-induced movement therapy with and without mitt poststroke. Archives of Physical Medicine & Rehabilitation, 91(3), 460-464 465p. doi:10.1016/j.apmr.2009.11.009.

Brogårdh, C., Vestling, M., & Sjölund, B. H. (2009). Shortened constraint-induced movement therapy in subacute stroke - no effect of using a restraint: a randomized controlled study with independent observers. Journal of Rehabilitation Medicine, 41(4), 231-236 236p. doi:10.2340/16501977-0312.

Papers exploring the transfer package:

Taub, E., Uswatte, G., Mark, V. W., Morris, D. M., Barman, J., Bowman, M. H., . . . Bishop-McKay, S. (2013). Method for enhancing real-world use of a more affected arm in chronic stroke: Transfer package of constraint-induced movement therapy. Stroke, 44(5), 1383-1388. doi:10.1161/STROKEAHA.111.000559.

Papers describing other remote models of CIMT delivery:

Smith, M. A., & Tomita, M. R. (2020). Combined effects of Telehealth and Modified Constraint-Induced Movement Therapy for Individuals with Chronic Hemiparesis. International Journal of Telerehabilitation, 12(1), 51–62. https://doi.org/10.5195/ijt.2020.6300

Lum, P. S., Taub, E., Schwandt, D., Postman, M., Hardin, P., & Uswatte, G. (2004). Automated Constraint-Induced Therapy Extension (AutoCITE) for movement deficits after stroke. Journal of Rehabilitation Research and Development, 41(3A), 249-258. doi:10.1682/jrrd.2003.06.0092.

Hughes, A.-M., Meagher, C., & Burridge, J. (2017). Arm Rehabilitation at Home for People with Stroke: Staying Safe: Encouraging Results from the Co-designed LifeCIT Programme. In I. Kollak (Ed.), Safe at Home with Assistive Technology (pp. 59-79). Cham: Springer International Publishing. doi:10.1007/978-3-319-42890-1_5.

Gauthier, L. V., Kane, C., Borstad, A., Strahl, N., Uswatte, G., Taub, E., . . . Mark, V. (2017). Video Game Rehabilitation for Outpatient Stroke (VIGoROUS): protocol for a multi-center comparative effectiveness trial of in-home gamified constraint-induced movement therapy for rehabilitation of chronic upper extremity hemiparesis. BMC Neurology, 17(1), 109. doi:10.1186/s12883-017-0888-0.

Carer experiences during CIMT:

Blanton, S., Scheibe, D. C., Rutledge, A. H., Regan, B., O’Sullivan, C. S., & Clark, P. C. (2019). Family-Centered Care During Constraint-Induced Therapy After Chronic Stroke: A Feasibility Study. Rehabilitation Nursing Journal, 44(6), 349-357. doi:10.1097/rnj.0000000000000197.

CIMT implementation:

Jolliffe, L., Hoffmann, T., Churilov, L., & Lannin, N. A. (2020). What is the feasibility and observed effect of two implementation packages for stroke rehabilitation therapists implementing upper limb guidelines? A cluster controlled feasibility study. BMJ Open Quality, 9(2), e000954. doi:10.1136/bmjoq-2020-000954.

McCluskey, A., Massie, L., Gibson, G., Pinkerton, L., & Vandenberg, A. (2020). Increasing the delivery of upper limb constraint-induced movement therapy post-stroke: A feasibility implementation study. Australian Occupational Therapy Journal, 67(3), 237-249. doi:10.1111/1440-1630.12647.

Christie, L.J., McCluskey, A. and Lovarini, M. (2021). Implementation and sustainability of upper limb constraint-induced movement therapy programs for adults with neurological conditions: an international qualitative study. Journal of Health Organization and Management, Vol. ahead-of-print, No. ahead-of-print. https://doi.org/10.1108/JHOM-07-2020-0297.

CIMT in different patient populations

Traumatic brain injury:

Morris, D. M., Shaw, S. E., Mark, V. W., Uswatte, G., Barman, J., & Taub, E. (2006). The influence of neuropsychological characteristics on the use of CI therapy with persons with traumatic brain injury. NeuroRehabilitation, 21(2), 131-137. PMID: 16917159.

Shaw, S. E., Morris, D., Uswatte, G., McKay, S., Meythaler, J. M., & Taub, E. (2005). Constraint-induced movement therapy for recovery of upper-limb function following traumatic brain injury. Journal of Rehabilitation Research & Development, 42(6), 769-778. doi: 10.1682/jrrd.2005.06.0094.

Cerebral palsy with hemiplegia:

Fonseca Junior, P. R., Filoni, E., Setter, C. M., Berbel, A. M., Fernandes, A. O., & Moura, R. C. d. F. (2017). Constraint-induced movement therapy of upper limb of children with cerebral palsy in clinical practice: systematic review of the literature. Fisioterapia e Pesquisa, 24, 334-346. doi.org/10.1590/1809-2950/17425124032017.

Chiu, H. C., & Ada, L. (2016). Constraint-induced movement therapy improves upper limb activity and participation in hemiplegic cerebral palsy: a systematic review. Journal of Physiotherapy, 62(3), 130-137. doi:10.1016/j.jphys.2016.05.013.

Hoare, B. J., Wallen, M. A., Thorley, M. N., Jackman, M. L., Carey, L. M., & Imms, C. (2019). Constraint‐induced movement therapy in children with unilateral cerebral palsy. Cochrane Database of Systematic Reviews(4). doi:10.1002/14651858.CD004149.pub3.

Congenital hemiplegia:

Sakzewski, L., Ziviani, J., Abbott, D. F., Macdonell, R. A. L., Jackson, G. D., & Boyd, R. N. (2011). Randomized trial of constraint-induced movement therapy and bimanual training on activity outcomes for children with congenital hemiplegia. Developmental Medicine & Child Neurology, 53(4), 313-320. doi:10.1111/j.1469-8749.2010.03859.x.

Parkinson’s disease:

Lee, K. S., Lee, W. H., & Hwang, S. (2011). Modified constraint-induced movement therapy improves fine and gross motor performance of the upper limb in Parkinson disease. American Journal of Physical Medicine & Rehabilitation, 90(5), 380-386. doi:10.1097/PHM.0b013e31820b15cd.

Multiple Sclerosis:

Mark, V. W., Taub, E., Uswatte, G., Morris, D. M., Cutter, G. R., Adams, T. L., . . . McKay, S. (2018). Phase II Randomized Controlled Trial of Constraint-Induced Movement Therapy in Multiple Sclerosis. Part 1: Effects on Real-World Function. Neurorehabilitation and Neural Repair, 32(3), 223-232. doi:10.1177/1545968318761050.

Barghi, A., Allendorfer, J. B., Taub, E., Womble, B., Hicks, J. M., Uswatte, G., . . . Mark, V. W. (2018). Phase II Randomized Controlled Trial of Constraint-Induced Movement Therapy in Multiple Sclerosis. Part 2: Effect on White Matter Integrity. Neurorehabilitation and Neural Repair, 32(3), 233-241. doi:10.1177/1545968317753073.

Focal hand dystonia:

Candia, V., Elbert, T., Altenmüller, E., Rau, H., Schäfer, T., & Taub, E. (1999). Constraint-induced movement therapy for focal hand dystonia in musicians. Lancet, 353(9146), 42. doi:10.1016/s0140-6736(05)74865-0.

Disclaimer

TeleCIMT resources has been produced in good faith by the TIDE group for the information and use by qualified healthcare professionals (occupational therapists and physiotherapists) only.

A TeleCIMT program is a specific, specialised program that is not intended to be suitable for all people after stroke or other neurological incident. The TIDE group does not make any representations or warranties as to the effectiveness of the program contained on this website.

The TeleCIMT program should be prescribed strictly by a healthcare professional i.e. registered occupational therapist or physiotherapist with experience in stroke or neurological rehabilitation. The TeleCIMT program can be adapted to individual participant or service needs.

The TeleCIMT resources on this website do not provide or constitute individual medical advice. The TeleCIMT program is to be used strictly as a guide only and is not a substitute for the advice, or prescribed course of treatment, of qualified physiotherapists, occupational therapists or medical practitioners.

Should you have any questions or problems regarding the use of this TeleCIMT program please consult your relevant occupational therapist or physiotherapist.

You hereby assume full responsibility for ensuring the appropriateness of any use of this TeleCIMT program, and you acknowledge that neither TIDE group nor any of the developers of this TeleCIMT program accept any responsibility for decisions made by you based on the TeleCIMT resources set out on this website.

To the maximum extent allowed pursuant to any applicable law, all content on this website is provided as is and without warranties of any kind either expressed or implied. The TIDE group disclaim all warranties, expressed or implied, including, but not limited to, implied warranties of merchantability and fitness for a particular purpose and accepts no responsibility for the use of these resources. The TIDE group does not warrant that the functions contained in the downloadable content will be uninterrupted or error-free or that defects will be corrected, or that the content itself will not change from time to time.

The TIDE group does not warrant that this website, the server or any sites to which this site may be linked are free of any viruses or other harmful components which may affect your mode (s) of accessing this site. You (and not the TIDE group) assume the entire cost of any and all servicing, repair, or correction of any portion of any computer equipment, network or other related devices you use to access this site.

The TIDE group does not warrant or make any representations regarding the use or the results of the use of the information on this website (or linked websites) in terms of their claims, validity, accuracy, timeliness, completeness, reliability, or otherwise. The websites which may be linked to this website are not necessarily created, managed, maintained or monitored by the TIDE group. The TIDE group is not responsible for any of the content of those linked websites. The inclusion of any link to such websites does not imply approval of or endorsement by the TIDE group of the websites or the content thereof. The TIDE group is only providing these links as a convenience to you.

The information and descriptions contained herein are not intended to be complete descriptions of all terms, exclusions and conditions applicable to the products and services, but are provided only for general informational purposes. Under no circumstances shall the TIDE group or its sponsors, contractors, partners, affiliates or other related parties be liable for any special, indirect or consequential damages whatsoever, whether in an action of contract, negligence or other tortuous action, arising out of or in connection with the use of the information herein. The material contained herein is not intended to be a complete description of all terms, exclusions and conditions, but is provided solely for informational purposes.

Exclusion of Liability

Participation in any of the exercises on this program is at your own risk. By viewing this program or performing the exercises described in this program, you acknowledge and accept that, to the extent permitted by law, the TIDE group or the developers of this TeleCIMT program will not be under any liability to you whatsoever, whether in contract or tort (including, without limitation, negligence), breach of statute or any other legal or equitable obligation, in respect of any injury, loss or damage (including loss of profit or savings), howsoever caused, which may be suffered or incurred by the viewer or any other person.

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Except as otherwise expressly permitted in writing by the TIDE group, no content (written text, images or audiovisual, in whole or in part) from this website may be copied, reproduced, republished, uploaded, posted, transmitted or distributed in any way. You may download material displayed on this website for your use only, provided that you also retain all copyright and other proprietary notices contained on the materials. You may not distribute to anyone, modify, transmit, reuse, repost, or use any content on this website for public or commercial purposes, including but not limited to text, images, audio, and video without written permission from the TIDE group. The TIDE group neither warrants nor represents that your use of materials displayed on this website or linked websites will not infringe the rights of third parties.

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