How is individualization in constraint-induced movement therapy performed? A qualitative observational study

Abstract

The aim of the study was to investigate relationships between the design of tasks and impairments in constraint-induced movement therapy (CIMT) and significant principles of in situ individualization in group-based performance of the intervention, focusing on quality of performance versus compensatory strategies in the more affected upper limb. Non-participatory observations of four individuals undergoing CIMT group training with a physiotherapist were conducted, followed by theme-based content analysis using concepts from practice knowledge and movement analysis as analytical tools. The material was characterized by the physiotherapist focusing on the quality of movements by interacting and making a variety of adjustments. Most tasks were too challenging in terms of shoulder stability and were performed using compensatory strategies. It appeared essential that participants’ could solve the task with optimal movement quality in addition to experiencing meaning and success. In conclusion, the physiotherapist’s individualizations in situ appeared to be based on goal attainment through optimization of movement quality. Interlinking the design of tasks with the individual patient’s underlying impairments, elements from activities in daily life and sense-making seem essential. Impairments occurred owing to high demands of dynamic stability in the shoulder, which may be a reason why participants in CIMT often use compensatory strategies.