Day 1 – The Cast is On! Constraint-induced Movement Therapy

This post is part of a mini blog series documenting four weeks of Constraint-induced Movement Therapy (CIMT).

Our day starts bright and early at the CIMT clinic in Manchester, UK. It’s the first day of my daughter’s four week intensive rehabilitation program and I’m a bit nervous. I’m feeling apprehensive about how she’ll react when the light-weight cast is applied to her functional arm. So far, she seems to be in good spirits. She’s nine months and seven days old, and I’m thankful her discomfort from teething seems to be behind us for now.

For the entire duration of the four week CIMT program, my daughter will have the cast on. The physiotherapist will change it just once per week so it’s important it doesn’t get wet. In addition to the cast, I’ll be taking her into the CIMT clinic for rehabilitation every day except on weekends. Outside of the sessions, we must stimulate her left arm and hand, and encourage her to use it throughout the day.

Ruth and Fetullah, the physiotherapists who will be working with our daughter, greet us with a warm welcome. They spend some time observing our daughter’s use of her left arm and hand. We hope and expect to see a lot of improvement in her use of it over the next four weeks. We’ll be focusing on helping her gain awareness of it by providing her with a lot of sensory experience and play-based activities.

The idea of Constraint-induced Movement Therapy (CIMT) is that by constraining the stronger arm, rehabilitation of the weaker arm can be facilitated more easily for people with hemiplegia. The impact is long-lasting results and significant improvements. You can find a lot of research online for the rehabilitation of hemiplegia in adults using CIMT.

It’s time for the cast

My husband sits our daughter on his lap and distracts her while Ruth very skillfully constructs the cast around her arm. I chose the color white because one of the brighter colors like red or yellow may draw her attention too much to it due to her Cortical Visual Impairment (CVI).

It takes no more than fifteen minutes and before I know it, my daughter’s right arm is all wrapped up. She hardly seems to notice. Considering she can’t exactly see what’s happening due to her Cortical Visual Impairment (CVI), I’m surprised she’s not throwing a fit! Within minutes, we can see her making an effort to use her unrestrained, weaker arm.

For the rest of the session, Ruth and Fetullah play with her using some of the CVI-friendly toys I brought along with me. They use her shiny red pom-pom, yellow slinky, pacifier, two-handled water cup, Mardi Gras beads, and red Elmo plush toy. These are all toys she’s highly familiar with. They also use their own solid colored sensory balls of different sizes, shapes and textures which she really seems to like.

Ruth has a beautiful voice and sings to my daughter. I am floored at how easily she can capture her attention. She gets her to open her left hand and even laugh using hand rhymes⁠—something I will for sure have to try at home!

The two-hour session is over before we know it and our homework is to let our daughter feel different textures. It could be as simple as our own skin, hair and clothing.

I feel today was a success! My daughter didn’t cry at all and didn’t seem to be uncomfortable at any point. She however did try to mouth the cast, especially when I placed her on her tummy.

It’s now almost midnight and I’m ready to call it a night. Tomorrow, we’ll be setting some goals for our daughter during the session. We’ll also be doing a video call with Dr. Christine Roman who will provide us with her suggestions on incorporating Cortical Visual Impairment (CVI) adaptations to the rehab environment.