Uses of constraint-induced movement therapy (CIMT) in patients with brachial plexus birth injuries (BPBI).

Constraint-induced movement therapy (CIMT) was originally implemented to address limb non-use in stroke recovery, and has more recently become a mainstay, evidence-based treatment approach to decrease developmental disregard in children. In addition to combating developmental disregard in the BPBI patient with residual deficit(s), CIMT can be applied in various ways across diverse cases in brachial plexus practice, including post-surgical use to aid in the activation of nerve transfers and/or tendon transfers. The timing, dosage, and setting of CIMT will vary depending on the patient's case and individual needs. This paper highlights how the individuality of CIMT implementation, when tailored to each patient's developmental stage and specific needs and circumstances outside of the clinic, contributes to its success. Rather than presenting the routine use of CIMT for BPBI developmental disregard, sample cases are presented to outline the variety of uses for CIMT in the surgical BPBI patient. Practical tips and clinical strategies are provided to support other clinicians in effectively incorporating CIMT in their care of children in this vulnerable population. Level of evidence: IV.