Constraint therapies focus on improving motor skills in the affected extremities of hemiplegic patients. These methods have been applied to children with cerebral palsy after they were shown to be successful in stroke rehabilitation. Despite the recent popularity of these interventions with cerebral palsy patients however, standard procedures still need to be defined by the professionals employing them (Gordon et al. 2005). Upon reviewing the literature however, two schools of practice become apparent. The following definitions are similar to those used by Charles and Gordon (2005) in their review of constraint therapies used with children.
First, constraint-induced movement therapy (CIMT) is an intervention that consists of two key elements: restraint and shaping. Restraints are placed on the less-affected upper extremity for a majority of a patient’s waking hours (usually 90%) for several consecutive days inciting use of the non-dominant arm. The restraint must be in place so as to eliminate the dominant hand from assisting in activities and thus forcing strictly unimanual activity. Shaping refers to intensive training where a patient repeats tasks that focus on gradual skill development in the unrestrained arm for at least six hours daily. Studies may use different types of restraint or shaping methods and still be categorized together under CIMT if they meet the intensity and duration criteria above.
The second school of constraint interventions will be referred to as forced-use therapy (FUT). This intervention category, although similar to CIMT in the fact that the less-affected arm is restrained, does not have minimum hours during which the arm must be restrained. In addition, shaping is not necessarily involved. Forced-use therapy is a more inclusive category than CIMT because there are no strict defining criteria involved, and thus acts as a catch-all category for non-CIMT studies.
