Intensive therapy: upper limb and lower limb

Intensive therapy for upper and lower limbs involves a comprehensive rehabilitation approach focused on improving motor function, strength, and coordination in both the arms and legs. This type of therapy typically consists of concentrated and repetitive exercises tailored to the individual's specific needs and goals. Intensive therapy for upper and lower limbs is often used to address impairments resulting from conditions such as stroke, spinal cord injury, or neurological disorders. By targeting both the upper and lower body, this therapy aims to maximize functional recovery, enhance mobility, and improve overall quality of life for individuals undergoing rehabilitation.

 

Upper Limb

Our team provide specialised intensive upper limb programmes for patients with upper limb deficits. With many benefits, including improved motor function, increased range of motion, enhanced independence and confidence and promotion of neuroplasticity, our upper limb rehabilitation can be tailored to each individual. Some of the common methods used within our practice include:

- Constraint-Induced Movement Therapy (CIMT) - CIMT involves restraining the unaffected arm while engaging in intensive training and functional tasks with the affected arm. This approach encourages the use of the affected limb and promotes motor recovery.

- Task-Specific Learning - Task-specific training focuses on practicing functional activities relevant to the individual's daily life. This therapy aims to improve motor control and coordination through repetitive practice of specific tasks.

- Strength Training - Strength training exercises focus on improving muscle strength and endurance in the upper limb. These exercises may include resistance training, weightlifting, or use of resistance bands to target specific muscle groups.

 

Lower Limb

Lower limb intensive rehabilitation refers to a specialized approach aimed at improving mobility, strength, and function in the legs and feet through concentrated and targeted

therapy interventions. Our comprehensive programs typically involve a combination of exercises, activities, and modalities designed to address specific impairments or limitations affecting the lower extremities. Some key components of lower limb intensive rehabilitation may include:

- Gait training - Gait training focuses on improving walking patterns and mechanics, including aspects such as step length, stride length, and weight-bearing, to promote safe and efficient mobility.

- Strength and Endurance Exercises - Targeted exercises are used to improve muscle strength, endurance, and stability in the lower limbs, helping individuals regain the ability to perform activities such as standing, walking, and climbing stairs.

- Balance and Coordination - Balance and coordination exercises aim to enhance proprioception, postural control, and stability, reducing the risk of falls and improving overall mobility and function.

- Functional Activities - Intensive rehabilitation often incorporates functional activities relevant to daily life, such as sit-to-stand transfers, stair climbing, and negotiating obstacles, to promote real-world mobility and independence.

- Manual Therapy - Manual therapy techniques, such as joint mobilizations, soft tissue mobilizations, and stretching exercises, may be used to improve joint mobility, reduce muscle tightness, and alleviate pain in the lower extremities.

- Neuromuscular Re-education - Neuromuscular re-education focuses on retraining movement patterns and motor control in individuals with neurological conditions or movement disorders affecting the lower limbs, facilitating improved coordination and function.

- Hydrotherapy - Hydrotherapy involves performing exercises and activities in a water-based environment, taking advantage of buoyancy and resistance to promote strength, flexibility, and cardiovascular fitness while minimizing stress on the joints.

Experience tailored intensive rehabilitation for your upper and lower limbs at The National Physio, where we are dedicated to helping you regain mobility, strength, and function for a better quality of life.

 

CIMT

Constraint-Induced Movement Therapy (CIMT) is a rehabilitation technique used primarily in the treatment of motor deficits resulting from conditions such as stroke, cerebral palsy, or traumatic brain injury. CIMT involves constraining the movement of the unaffected limb while intensively training the affected limb. By restricting the use of the unaffected limb, CIMT encourages the brain to rewire and relearn motor skills, promoting functional improvement in the affected limb. Our team has many years of experience in providing CIMT to hemiplegia patient's.

 

CIMT was developed in the late 1980s by Dr. Edward Taub and his colleagues at the University of Alabama at Birmingham, initially for adults with stroke-induced hemiparesis. Later, its application was extended to children with hemiplegic cerebral palsy. The evidence supporting the effectiveness of CIMT in children has been derived from various research studies conducted in paediatric rehabilitation centres worldwide. These studies have typically involved controlled trials comparing CIMT with conventional therapy or no

treatment, demonstrating significant improvements in motor function, activities of daily living, and neuroplastic changes in the brain associated with CIMT interventions.

 

Papers: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4361809/ - CIMT in stroke patient's https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4361809/ - CIMT in CP children https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3501420/ - CIMT benefits and how it works

 

Paediatric

CIMT is a specialized rehabilitation approach tailored for children with hemiplegia, focusing on enhancing movement and function in the affected arm and hand. CIMT involves intensive training of the weaker limb while constraining the stronger limb using a lightweight cast or sling. It entails utilizing behaviour-analytic strategies to address deficiencies stemming from various forms of significant damage to the central nervous system (CNS), including stroke, traumatic brain injury, spinal cord injury, multiple sclerosis, cerebral palsy, and other motor disorders commonly found in paediatric patients. This method has been extensively researched and shown to yield significant and enduring improvements not only in limb mobility but also in neurological function. CIMT programs are typically short yet intensive, with daily sessions spanning 3 to 4 weeks under the guidance of our experienced paediatric physiotherapists. The length of the programme is determined by one of our hemiplegic specialists in a thorough initial assessment. Through CIMT, children can achieve meaningful gains in motor skills and independence, paving the way for enhanced quality of life and participation in daily activities. Our team has extensive experience in providing programmes to hemiplegic children of all ages, starting as early as 8 months old.

 

Who is suitable for CIMT?

Children with hemiplegia or hemiparesis resulting from conditions such as cerebral palsy, stroke, or traumatic brain injury are suitable candidates for Constraint-Induced Movement Therapy (CIMT). Additionally, CIMT may benefit children with other neurological conditions causing unilateral motor deficits. Generally, CIMT is recommended for children who have some voluntary movement in the affected limb and are motivated to participate in intensive therapy sessions. However, suitability for CIMT is determined on a case-by-case basis by our professionals, considering factors such as age, cognitive abilities, and overall health status.

 

Why is casting the weaker arm beneficial?

Children experiencing hand and arm weakness due to neurological impairment often adopt compensatory techniques from an early age. Utilizing the weaker arm proves challenging or ineffective, while the stronger arm enables them to accomplish tasks effectively. Consequently, as the child develops and gets older, they favour their dominant side, with limited opportunities for stimulation or engagement of the weaker side in functional activities. Due to the increased strength in the dominant side, everyday tasks such as dressing, eating and generalised movement are completed in the absence of the weaker side.

 

In our CIMT programmes, we cast the child's stronger arm in a light-weight cast to reroute the patient's attention to utilizing the use of their weaker side of the body. Restricting the

use of the stronger arm compels the child to rely more on the weaker arm during therapy sessions. This focused and intensive use of the weaker limb helps stimulate neural pathways and promotes motor learning and functional improvement.

 

Why is doing at a younger age better?

Engaging in Constraint-Induced Movement Therapy (CIMT) at a younger age offers several advantages for children with neurological impairments. Firstly, younger brains tend to exhibit greater plasticity, meaning they are more adaptable and responsive to therapeutic interventions ( https://www.researchgate.net/profile/Joan-Stiles/publication/12052494_Neural_plasticity_and_cognitive_development/links/0fcfd5123909f101cf000000/Neural-plasticity-and-cognitive-development.pdf) . This increased neuroplasticity enhances the potential for neural rewiring and functional recovery following CIMT. Secondly, starting CIMT early allows for the establishment of more efficient motor patterns and skills, potentially mitigating the development of compensatory strategies that may impede progress later in life. Additionally, younger children often have higher levels of motivation and enthusiasm for engaging in therapeutic activities, which can contribute to more successful outcomes with CIMT. Overall, initiating CIMT at a younger age maximizes the therapeutic window of opportunity and optimizes the potential for long-term functional gains and improved quality of life.

 

Why us (e.g travel the world to do CIMT)?

At The National Physio, we understand the importance of accessibility and convenience when it comes to rehabilitation, which is why we're proud to offer Constraint-Induced Movement Therapy (CIMT) services that can be delivered directly to you, wherever you are in the world. Whether it's in the comfort of your own home, at a care facility, or any other convenient location, our team is dedicated to bringing the benefits of CIMT to your doorstep. By providing mobile CIMT sessions, we ensure that you or your child can receive the therapy you need without the hassle of traveling to a clinic, taking time off work and interrupting daily activities. Our experienced therapists will work with you to create a personalized CIMT program tailored to your specific needs and goals, helping you achieve meaningful and lasting improvements in motor function and quality of life. With The National Physio, CIMT is more accessible and convenient than ever before, offering an option that brings therapy to you.

 

Do the results of these programmes last forever?

The long-term effects of Constraint-Induced Movement Therapy (CIMT) can be significant and enduring. Research suggests that CIMT not only improves motor function in the short term but also leads to sustained gains over time. By promoting neuroplasticity, CIMT helps rewire the brain, facilitating lasting improvements in movement, coordination, and functional independence. Additionally, CIMT can prevent or minimize the development of compensatory strategies, leading to more efficient and effective use of the affected limb in daily activities. Furthermore, the benefits of CIMT extend beyond physical function, often resulting in improved quality of life and enhanced participation in social and recreational activities.

 

It is not unusual for certain improvements to gradually diminish over time, especially as a child progresses in development and encounters the need to acquire new skills. Studies have

indicated that the benefits of CIMT typically endure, as evidenced by follow-up investigations conducted 6 months to 2 years post-program completion. Crucially, the neurological alterations induced by CIMT have also demonstrated long-lasting effects, reinforced by further treatment . https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1469-8749.2007.00770.x

 

 

Adult

CIMT is an intensive rehabilitation programme, suitable for both adults and children. Our hemiplegia specialists provide short but intensive programmes for adults. Our programmes improve motor function in individual's with neurological conditions, such as cerebral palsy, post-stroke, traumatic brain injury or multiple sclerosis. These programs involve intensive training of the affected limb while restraining the unaffected limb, encouraging the use of the weakened side for daily activities. Adult CIMT programs typically consist of structured therapy sessions conducted over a period of 2 or 3 weeks, with a focus on promoting neuroplasticity and functional recovery. The goal of adult CIMT is to enhance motor skills, regain independence in activities of daily living, and improve overall quality of life for individuals affected by neurological impairments.

 

Our team has many years of experience providing CIMT to hemiplegic patient's. A removeable cast is applied to the patient's weaker side, to promote focused rehabilitation to the affected side. By immobilizing the stronger limb, typically through casting, CIMT encourages individuals to engage actively with the weaker limb during therapy sessions. This intensive and repetitive use of the affected limb helps stimulate neural pathways, promoting motor learning and functional recovery. Additionally, casting the stronger side helps prevent reliance on compensatory movements, encouraging individuals to challenge themselves and maximize their potential for improvement. Overall, casting the weaker side in adult CIMT programs facilitates targeted rehabilitation, leading to enhanced motor function and greater independence in daily activities.

 

At the National Physio, we bring this intensive treatment option to you. Our mobile CIMT program brings expert therapy directly to you, eliminating the need for travel or inconvenience. Whether you prefer the familiarity of your home environment or have mobility limitations that make clinic visits challenging, our hemiplegic specialists will work with you to develop a personalized CIMT program tailored to your needs and goals. With our flexible scheduling and convenient home-based sessions, you can receive the therapy you need without disruption to your daily routine. Trust The National to bring quality CIMT services to your doorstep, helping you achieve lasting improvements in motor function and quality of life.

 

Bimanual therapy

Bimanual therapy is a type of rehabilitation approach that focuses on improving the coordination and function of both hands simultaneously. This therapy is often used for individuals with neurological conditions or injuries that affect the use of both hands. Bimanual therapy may involve various activities and exercises designed to promote symmetrical movement, strength, dexterity, and coordination between the hands. It can be beneficial for improving fine motor skills, grasping abilities, and overall hand function. Our

specialist physiotherapists provide rehabilitation tailored to meet the specific needs and goals of each individual. By incorporating the use of both hands, functional independence is increased, enhancing confidence in daily activities.

 

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