Constraint-induced movement therapy: time for a little restraint?

Abstract

Our aim was to consider some issues surrounding constraint-induced movement therapy (CIMT), and in particular, its theoretical basis, effectiveness, utility and composition. We examined selected articles and related publications concerning CIMT. Considerable evidence from case studies and case series has accumulated but only a limited number of randomized controlled trials (RCTs) exist. The two most positive RCTs represent a combined total of 15 people undergoing CIMT. Other issues include: how analogous deafferentation of an upper limb in monkeys is to cerebral infarcts in humans; teasing out the active components of CIMT; a need for replication by groups not already strongly associated with CIMT; and patient/therapist acceptability. CIMT may hold considerable promise, but independent, large-scale, multicentre RCTs comparing its effectiveness with conventional therapy of equal intensity are required, as is the consideration of some associated issues.