Sunday, March 27, 2011

Modified Constraint-Induced Movement Therapy

For the last two weeks I went to Spaulding everyday to try to recover more movement for my right hand. I did a program called Modified Constraint-Induced Movement Therapy (M-CIMT).

Warning: this post is much longer than usual. I wrote this summary since some stroke survivors I know were curious about this program, especially since the price is so reasonable.

The program

Every day from 1 - 3pm, five stroke survivors, including myself, gathered around a big table. After our occupational therapist (OT) led us in some stretching (both hands), we were asked to put our less-affected hand in our lap.

Then the fun began.

We would warm up by rolling a ball to each other for about 15 minutes. Then the OT and aide opened the big cupboards behind us and brought out the toys: jumbo pegboards, little pegboards, puzzles, games, kitchen utensils, beads big and small, cards, etc. There were other toys that only an OT would have: hand putty in all grades of resistances, adaptive writing tools, stacking cones, the Amazing Clothespin Contraption, and my favorite, a little "skateboard" for a hand.

The OT would picked out the things that she thought would help the most, depending on the individual person and problem she was working on at the moment. Usually we worked alone or in pairs, and then switched to new activities after 15 or 20 minutes.

Every so often if someone was struggling to remember to use only their affected hand, the OT would bring out the big mitt to constrain their "good" hand. Other times we did bi-manual activities, so the mitt was irrelevant.

After two hours most of us were exhausted. Before going, we had to bring out our checklist for activities for the evening or next morning, for a total of two hours. For instance, some of activities I worked on were: turning pages; stringing beads; tying a bow; playing scales on the piano. For another person, the activities might include drinking from a plastic cup with a handle; eating finger foods; wiping a table with a circular pattern; using a rolling pin with both hands.

Five hands, five different recoveries

We were all very interested to see how different our problems are--and also similar. For instance, I and another person were always dropping things. Another person could inadvertently crush a water bottle in his hand; his challenge was to pry his fingers off it. My sensation is diminished, and another person reported that his sensation had just returned after two years, apparently very suddenly. Most of us had shoulder issues.

As a 47-year-old, I was the youngest participant, but no one could be called elderly either. Most of the people were working before stroke. (I wasn't working at the time of my stroke. But parenting young kids is hard labor, either paid or unpaid). I think every one was at least one year post-stroke.

My decision to participate was partly a financial decision. Although my hand is partly functional, I need a lot of therapy before I will be anywhere near back to doing normal household tasks. (Playing piano--which I used to do--is another whole level) . We had two options to pay for the group: use insurance, or private pay, which had a flat fee of $40 per session ($400 in total). Given that there's a chance that my insurance won't authorize more than a handful of visits this year, the group bought me a lot more therapy for my buck.

By contrast, the Taub Clinic, the pioneer of CIMT, charges $6000 for two weeks of half-day private treatment.

Our OT told us: "this isn't a magic cure." You have to work incredibly hard. But hopefully this can help people by jump starting their recovery, or this phase of their recovery. For me, the best part was that I got a lot of ideas to challenge myself at home. The moral support from other stroke survivors was incredibly helpful.

As always, the therapists at Spaulding were fantastic. They were so skilled with figuring out how to help each individual the right mix of encouragement and sensitivity. And humor.


  1. I was happy to read about your initial experience with CIT. I live alone after having a stroke so getting through my day has forced me to use both hands. Now my hemiplegic hand helps me do over 100 ADL tasks. Research has shown that forced use can produce results even 10 years after a stroke. But your OT is right about having to work hard. Think about the hundreds of times your PT had to put weight on your hemiplegic leg.

  2. Thank you for reading, Rebecca. Your blog is fascinating.

  3. So much of rehab takes place after we leave the hospital. If stroke survivors do not share our experiences we take what we have learned to our graves.

  4. Grace I really liked hearing some details. I have seen bits and pieces of information about constraint style therapies but I have never spoken to someone who actually gave it a shot. I love the pictures too. I have been more like the water bottle crushing participant and I have yet to actually meet someone with that problem.

    I had a fair bit of hand arm therapy at first and I am doing well now but I think this kind of more extensive guidance would have done me a world of good. I am glad you got to go.

    I had an interesting talk with several elderly stroke ladies. They stated that they thought they had better use of their hands than some of the males in the room because they kept trying to knit and crochet. Talk about repetitive hand use making all those afghans!

    Linda in Winnipeg

  5. Although I'm loathe to admit it, housework is great form of therapy.

  6. Grace: Thanks so much for this post - I've been meaning to follow up with you to get a status report. How are you feeling now that it's been a couple more weeks?

  7. A little more rested!

    This week I'm supposed to do the Jebsen-Taylor test. I'm not sure if my score will be better. However, I'm pretty sure that I'm using my hand more since the program, so I'm satisfied.

  8. So I'm dying to know how CIMT is going. I also can't believe the Taub center would take advantage of people by charging $6,000.

  9. The group is over--it was two weeks. I still haven't had the Jebsen-Taylor test after, but I think it was worth it (see the comments above).

  10. Hi, and thanks so much for this wonderful blog! I'm a physical therapist, and I just posted a link to your modified CIMT blog on my stroke rehab informational website. You can check it out here:

    I hope you don't mind?
    And I would love for you to return the favor by posting to my website (, if you approve of my site, of course.



  11. Thanks Randy.

    I'm sorry but I only list other survivors' blogs.(I do make an exception for Peter Levine's, because his book is too important to leave off.)

  12. Would you have a contact name/number for the constraint induced program at Spaulding? I can't find any information about it on their website.

    1. I don't know they don't publicize it! I also don't know if they still do CIMT. You could call the main outpatient number, and ask for one of the OTs who does neuro rehab. You could also email me at, and I can send you the names of the OT's I worked with.