Modified pediatric constraint-induced movement therapy (mP-CIMT)
Occupational therapists at Children's Health℠ use modified pediatric constraint-induced movement therapy (mP-CIMT) to help children with arm weaknesses gain strength, movement and function. Children’s Health is one of the only pediatric hospitals in the region offering this specialized type of occupational therapy for children.
What is modified pediatric constraint-induced movement therapy (mP-CIMT)?
mP-CIMT is a specialized, intensive type of occupational therapy (OT) for children with nerve problems that affect their ability to use an arm or hand. Your child will wear a soft, removable cast during therapy to restrict the use of their stronger limb so they will use their weaker limb more. Your child’s weaker limb grows stronger. Eventually, your child will use both limbs.
Children’s Health has one of the only modified pediatric CIMT program in our region where occupational therapists work one-on-one with children to ensure therapy success. Your family’s participation is also critical. Your child’s therapist will customize an at-home program and teach you how to do exercises with your child to improve limb usage.
What are the benefits of modified pediatric constraint-induced movement therapy (mP-CIMT)?
mP-CIMT helps a child with nerve problems improve function, strength and movement in a weak arm or hand. The medical term for muscle weakness on one side of the body is hemiparesis.
The constraint part of this therapy (the removable cast on the stronger arm) enables your child to use the weak arm to complete tasks. The exercises that you and our therapists perform with your child strengthen the limb and improve function. As your child repeats these exercises over and over, new networks form in the brain. The repetition and new networks lead to improved limb control and movement.
With mP-CIMT, your child learns to use both arms and hands equally.
A child who participates in mP-CIMT benefits from:
More spontaneous use of the weak limb
Increased range of motion
Improved ability to perform two-handed tasks
Enhanced fine motor skills
Reduced frustration with two-handed tasks
Greater independence and autonomy
Better overall quality of life
Increased opportunities to participate in social activities, physical activities, hobbies and other functions
What are the side effects of modified pediatric constraint-induced movement therapy (mP-CIMT)?
Modified pediatric CIMT is very safe and has no side effects.
What are the risks of modified pediatric constraint-induced movement therapy (mP-CIMT)?
mP-CIMT is a very low-risk therapy. At Children’s Health, we use removable casts molded to comfortably fit your child. Because your child only wears the cast for a set number of hours each day, there’s little risk of skin rashes, infections or muscle weakening (atrophy).
Some children become frustrated at the initial lack of independence that comes with not being able to use their preferred, stronger limb to perform tasks. You may expect some tears and tantrums.
Wearing a cast can also affect your child’s balance when they walk or run. A fall could lead to an injury.
What to expect with modified pediatric constraint-induced movement therapy (mP-CIMT)
mP-CIMT is a team effort between your child, our occupational therapists and you. Working together, we can help your child get great results and improve function of the weak arm or hand.
While at Children’s Health, your child works one-on-one with occupational therapists who have advanced mP-CIMT training. At-home therapy is equally important. Your full commitment and participation are critical to your child’s success.
What to expect before modified pediatric constraint-induced movement therapy (mP-CIMT)
During your child’s initial evaluation, our occupational therapists assess how well your child uses their arms and hands to complete tasks. Your child completes various tasks using only the weak limb and then both limbs together. We evaluate range of motion, grip and pinch strength.
The constraint part of mP-CIMT means that your child wears a removable cast on their stronger arm. The cast runs from above your child’s elbow to their fingertips.
During casting we:
Place a soft, sock-like material over your child’s arm.
Wrap wet, gauze-like material around the arm.
Wait for the material to dry.
Use scissors to cut off the cast.
Insert padding along the edges of the cast for added comfort.
Put straps on the open (cut) section of the cast, so you can easily put the cast on and off.
What to expect during modified pediatric constraint-induced movement therapy (mP-CIMT)
mP-CIMT is an intensive program. How long your child needs mP-CIMT depends on their age, their unique condition and how well they respond to the therapy.
For children 2 and older, we typically recommend two hours a day of hospital-based occupational therapy, five days a week for at least three weeks.
For children younger than 2, we recommend shorter (30- to 45-minute) sessions fewer times a week. You and your child’s therapist will discuss the therapy plan at the time of the initial evaluation.
Your child wears the cast during the hospital sessions and for a set number of hours during home therapy sessions. You can remove the cast for baths, sleeping and other times as recommended by your child’s occupational therapist.
mP-CIMT focuses on two key components:
Repetition (also called mass practice) - You or your child's therapist encourage your child to complete lots of repetitions of specific movement patterns. For instance, your child rotates their hand to flip over a toy, or they reach their arm above their head to grab an item.
Increasing difficulty (also called shaping) - We gradually increase the difficulty of the activities while still ensuring that your child can successfully complete the tasks.
During sessions, our occupational therapists may also use neuromuscular electrical stimulation (NMES) to improve your child’s arm strength and coordination. This painless therapy delivers mild electrical pulses to activate muscles.
What to expect after modified pediatric constraint-induced movement therapy (mP-CIMT)
Throughout the program, we monitor and evaluate your child’s progress. Upon discharge from the program, we create a customized program to meet your child’s unique needs. We encourage you to continue doing activities at home to help your child maintain and build on the progress they’ve made. When needed, we offer refresher mP-CIMT sessions.
How do I prepare my child for modified pediatric constraint-induced movement therapy (mP-CIMT)?
Depending on your child’s age, you can talk to them about how wearing a cast can help them strengthen the weak arm. Some kids are excited about the idea of wearing a cast. If the excitement wears off, remind them that you can remove the cast after they complete their exercises. Let them know that you will attend mP-CIMT sessions with them so you can practice the activities at home.
What questions should I ask my provider about modified pediatric constraint-induced movement therapy (mP-CIMT)?
You may want to ask your occupational therapist questions like:
How will mP-CIMT help my child?
How often should my child attend mP-CIMT sessions?
How long are the sessions?
What if my child gets frustrated with wearing a cast?
What can I do to help my child improve their arm use and function?