Adélie’s Therapy – CIMT after a Brain Injury

Pour la version originale de cette publication (version française), cliquez ici.


Adélie’s Therapy

Adélie’s injury has long been an uneasy subject for me, especially when we were still in the hospital hearing details about her injury and recovery from her neurological team. Having already lost my little Zackaël and suffering a deep depression, I found it difficult to stand up when discussing results (such as an MRI) about Adélie’s brain. The main subject of this post isn’t about the details of her injury, in fact I don’t even have all of those details. Instead, I will discuss a type of therapy we are undertaking with Adélie.

Our little Adélie suffered a traumatic brain injury (TBI) when the moose impacted on the left side of her head, which unfortunately resulted in permanent damage. In a previous post, Adélie’s Update, I talked a bit about some of Adélie’s disabilities, specifically on the right side.

Hemiparesis: a condition caused by brain damage or spinal cord injury that leads to partial paralysis or weakness on one side of the body. It causes weakness, problems with muscle control, and muscle stiffness.

Adélie in the hospital (January 3, 2020). She does not use her left hand yet but is starting to realize that her right hand “exists”.

For Adélie, the damage to the left side of her brain resulted in hemiparesis of her right limbs. As she began her recovery, Adélie used neither her right hand nor her right arm, instead using the left side for everything. Fortunately, her young age works in her favour (she was 2 at the time of the accident). The damaged brain tissue cannot regain its functionality, but other parts of her brain may take over some of the responsibilities of the damaged area. Rehabilitation is therefore important in order to facilitate this learning process.

Constraint-induced movement therapy (CIMT)

In the early 1990s, a study involving monkeys, supervised by a neuroscientist Edward Taud, made major breakthroughs in the area of neuroplasticity. He discovered and developed the constraint-induced movement therapy (CIMT) which helps people who have developed a “learned non-use” as a result of a neurological injury. CIMT is used to help people suffering from hemiparesis to retrain the arm and hand of the paralyzed side of their body.

In the study, the scientists immobilized (restrained) the monkeys’ stronger limbs, which many would have thought would leave the monkeys helpless. The monkeys were therefore forced to use their affected limbs, their “weaker side”. To the surprise of many, the monkeys gradually all started using their weaker side to eat, play and function.

With CIMT, the repetitive exercises induce the development of new neural pathways in the brain, and the patients learn to use the paralyzed limb again. Taub’s reasoning was that a monkey will not use the weak arm if it can rely on its good arm instead. If both arms are weakened, however, it will be forced to use them. This might seem paradoxical, but the hypothesis was confirmed by the experiments.

“Even though it’s an intensive program where they’re training the arm, you’re really training the brain, not the arm.”

Lynne Gauthier, ASSOCIATE PROFESSOR in physiotherapy AND KINESIOLOGY – University of Massachusetts Lowell – LINK TO SOURCE

CIMT might be beneficial for patients who encountered the following conditions:

  • Stroke
  • Traumatic Brain Injury (ex. Adélie)
  • Cerebral Palsy
  • Multiple Sclerosis
  • Spinal Cord Injury
  • Other neurological conditions

Patients with Hemiparesis will often be discouraged from using the affected limbs because of the difficulty they encounter. We experienced this with Adélie, she was involuntarily starting to develop this “learned non-use” which can actually lead to further deterioration of her unused limb. It was so easy for her to use her left hand, but extremely hard for her to even lift her right hand. For a long period of time, her right hand used to be completely clenched and she seemed unaware that her right hand even existed.

During her hospital stay, in addition to the physio, Carl and I would stretch her hand several times per day. Her right hand would often be cold and blueish from no circulation. We finally began to see signs of her being aware of her right hand months after the accident.

The TCIM was suggested to us for Adélie. We figured Adélie would be ready for IMCT once she learned to walk again. However, Covid and the cancellations of its therapies meant that the TCIM trial had to be postponed. So it was in October 2020 that we were finally able to move forward with this therapy.

We had the option of a permanent or removable cast. As we know how determined our little Adélie can be, we opted for the permanent cast. With a removable, it could get difficult take it off and put it back on if she didn’t cooperate. With a permanent one, we have no choice, it cannot be taken off and it will be on her 100% of the time.

On October 6, Adélie’s left arm (“her strong side”) was completely cast all the way down to her fingertips to force her to use her right side, her “weak side”. The right hand was thus used intensively, after having been barely used at all by Adélie for almost a year since the accident.


CIMT was difficult during the first few days, especially at bedtime. Adélie was crying and begging me to take her off the cast, “enlève” she cried. It was uncomfortable for her. She would get frustrated because her right hand was very limited in what it could do. We therefore had to help her more and comfort her while explaining that it couldn’t be removed.

Adélie got used to it pretty quickly. She is a true champion. Unfortunately, during the time of her therapy, she contracted a urinary tract infection from a very resistant bacteria. This made her feel unwell (fever, lack of energy, etc), so we decided to stop the therapy after 18 days, only a few days shy of our planned 3 weeks of CIMT.

We are planning another CIMT in mid-January. The therapy will probably be repeated a few times a year. At this point, we don’t know if Adélie’s hand and arm will ever be able to return to normal. CIMT is still a therapy which is recent and is still the subject of several ongoing studies.

Adélie’s left hand once the cast removed


For Adélie, the rehabilitation will continue for several years. She has made so much amazing progress already, in all aspects of her life, and we’re confident that her little brain will continue to rewire and pick up neurons from elsewhere to make up for those damaged on her left side of her brain

“The brain is very stable unless it has to change”

Dr. Nico Dosenbach, Pediatric Neurologist and Systems Neuroscientist at Washington University School of Medicine – LINK TO SOURCE

We will always continue to work hard with Adélie. In fact, over the past week we have received lots of positive feedback from his therapists and educators at the daycare. We all noticed impressive improvement in her right-side limbs. She is using her right hand more and more for the activities she does. Bravo Adélie, we are proud of you!

That’s it for now!

Please share your thoughts in the comments below.
If you enjoyed this post, please enter your email and click “Follow” to know once my next post is out!

Source: A Scientist’s Pink Cast Leads To Discovery About How The Brain Responds To Disability, Jon Hamilton, June 18, 2020, https://www.npr.org/sections/health-shots/2020/06/18/877621475/a-scientists-pink-cast-leads-to-discovery-about-how-the-brain-responds-to-disabi,

22 thoughts on “Adélie’s Therapy – CIMT after a Brain Injury

  1. Toi et Carl vous êtes tellement de beaux modèles pour Adélie! Je suis certaine que tu vas inspirer d’autres familles avec ton blog! C’est incroyable tout ce que tu fais!! Tu es extraordinaire Brigitte!!

    1. ah Annie, quel beau message, merci énormément! On essaie de notre mieux. Pour moi-même, ça m’aide beaucoup de pouvoir partager, que ce soit de nos expériences, de Zackaël, Adélie, etc. Merci de lire et commenter, c’est très apprécié! Je vous souhaite une belle année 2021!

  2. Je suis persuadée que cette thérapie améliorera considérablement la motricité d’Adélie. Je suis droitière et j’ai eu le bras droit immobilisé pendant 1 an à cause d’une fracture qui ne voulait pas guérir. J’ai donc été forcée d’utiliser mon bras gauche et franchement, je suis devenue pratiquement ambidextre. Après cette expérience, mon bras gauche est resté plus fort qu’avant mon accident. C’est ce qui me fait croire que cette thérapie peut vraiment être efficace, d’autant plus que le cerveau d’Adélie est plus jeune que le mien!

    1. Salut Madge, merci pour ton commentaire. Je crois que je me rappelle de ton bras, c’était après un accident de bicycle je pense. Le corps humain est effectivement assez surprenant, il s’habitue assez vite, surtout quand on n’a pas le choix. Il nous a été recommandé de reporter la thérapie au printemps (car apparemment c’est difficile en hiver pour un enfant), je suis très persuadée que ça va continuer à l’aider beaucoup. Je te souhaite une bonne année, au plaisir!

  3. Bravo Adelie! Une vrai championne, tu vois qu’elle est déterminer, et elle va réussir!!! Elle doit suivre son grand frère, donc watch out! 😊. Elle va faire son chemin.
    Bravo maman, papa et Maxandre pour votre beau travail! Xo

  4. What an amazing and determined little lady. I can only imagine how frustrating it would be for her to have her left arm in a cast. I am glad she adapted quickly. Keep fighting little one!

  5. What a smart, beautiful, brave and inspiring girl. I could say the same about her maman! You guys are doing such an amazing job with Adélie. I’m so glad that the research/therapy exists to help support her. Adélie has shown us all how resilient she is. Nothing she accomplishes will ever cease to amaze me.

  6. Adelies spirit is so amazing. Even with the cast and the UTI, she was in a great mood most of the time. She would play with me, and I would have to duck out of the way when she was swinging her casted arm around. Her energy level never seems to wane. A very determined little girl

  7. Bravo Alélie, Brigitte et Carl!!! Vos efforts et votre résilience sont récompensés par de résultats positifs!!! Bravo!

  8. Elle est forte Adélie. Je vois tellement une belle progression depuis cet été. Tant au niveau de son équilibre que de la voir toujours en train de courir. Je suis certaine qu’elle y arrivera et deviendra de plus en plus forte. Cet hiver elle voudra suivre son frère dans la montagne et devra utiliser ses deux mains, ça finira pas être de plus en plus naturel. En plus elle a des parents extraordinaires qui font tout pour qu’elle continue un pas à la fois sa progression.

    1. merci France! oui effectivement elle continue à faire de beaux progrès! Elle adore voir Maxandre et tes enfants s’amuser dans la neige, espérons que la belle température continuera! ps. Maxandre a reçu une pioche comme cadeau à sa fête, il est très content! Les deux vont pouvoir piocher en même temps, hihi!

  9. Thank you for sharing. I have thought of your daughter often since the accident. I hope her recovery continues to go well.

  10. Bravo Adélie! Tu es une vraie championne! Continue tes beaux efforts. Brigitte et Carl, il est évident que vos efforts portent fruits. Bravo à vous tous 🙂

  11. Her progress is indeed amazing! She is so much fun to work with, playful, curious and yes, full of determination! Elaine (occupational therapist)

  12. Amazing work Adélie, mom, and dad! Rehabilitation is a long process, Adélie is improving remarkably, she is a little superstar and she’s also fortunate to have such loving and supportive parents. I think the permanent cast was the right choice, must have been so difficult when she asked to take it off though! Continue to trust your parent instincts when making these decisions. You know what’s best for your daughter. 👏🤩💐🥰

    1. Merci Crystal pour ton message. Adélie est très courageuse et s’habitue assez vite à toutes ses thérapies. Elle est très mignonne aussi avec ses thérapeutes, on l’aime tellement! xox

Leave a Reply

Your email address will not be published. Required fields are marked *