Some restraints restrict the wearer from using their hand and wrist, though allow use of their non-involved upper extremity for protection by extension of their arm in case of loss of balance or falls.
However, modified CI therapy protocols have shown larger treatment effects when administered in the acute phase.
[1] As a result of the patient engaging in repetitive exercises with the affected limb, the brain grows new neural pathways.
[20][22][23][24] A consistent exclusion criterion for CIMT and modified CI therapy has been the inability to perform voluntary wrist and finger extension in the involved hand.
Also like CIMT, CIAT has been shown to not be feasible in most clinical environments due to its parameters and distributed protocols are now being investigated.
[29] As stated earlier, the "traditional" form of constraint-induced movement therapy (CIMT) has not been incorporated as part of standard practice for the rehabilitation of the hemiplegic upper extremity.
[4] Concerns have also been raised over the generalizability of the results obtained from research, as selection criteria for CIMT research has excluded patients with a moderate or more severe stroke, due to balance problems, serious cognitive deficits, and global aphasia, which may reduce understanding of safety instructions and interfere with a patient's ability to communicate difficulties.
[31] CIMT can be prohibitively expensive for patients paying out-of-pocket or for publicly funded health care systems attempting to make this program available to all eligible stroke survivors.
[30][31] The patient's ability to tolerate the intensity and duration of the therapy sessions is a limiting factor to protocol adoption.
Stroke patients have commonly expressed the length of time wearing the constraint and time-consuming hours of therapy as reasons they wish not to participate.
[31] While the CIMT protocol results in improved function in its target population, it is unknown whether the combination of constraint and therapy is necessary to achieve the outcome seen or whether the benefit is due to exposure to high-intensity, task-specific activities focused on the use of the more affected limb.