Constraint‐Induced Movement Therapy: A Paradigm for Translating Advances in Behavioral Neuroscience into Rehabilitation Treatments

Taub, Edward; Uswatte, Gitendra

doi:10.1002/9780470478509.neubb002066

Cited by 8 publications

(5 citation statements)

References 148 publications

(126 reference statements)

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“…CIMT and mCIMT are forms of therapy that help stroke victims regain the use of affected limbs (American Stroke Association, 2004)16 ) . For CIMT, the level of evidence varied from level III to level I (Table 1).…”

Section: Resultsmentioning

confidence: 99%

“…Practitioners say that stroke victims disabled for many years have recovered the use of their limbs using CIMT. In fact, CIMT therapy is “at the forefront of a revolution” in the field of neuro-rehabilitation in terms of recovery for stroke survivors16 ) . Although there are differences between the two therapies, they both share the concept of incorporating physical constraint of the unaffected limb in order to facilitate use of the paretic limb17 ) .…”

Section: Introductionmentioning

confidence: 99%

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Post-stroke motor recovery and cortical organization following Constraint-Induced Movement Therapies: a literature review

Bani-Ahmed

2019

J Phys Ther Sci

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[Purpose] This review synthesizes findings from studies on two forms of Constraint-Induced Movement Therapies: the original Constraint-Induced Movement Therapy and the modified Constraint-Induced Movement Therapy, in adult stroke patients including the evidence, current limitations and future directions. [Methods] We critically reviewed studies evaluating the effectiveness of Constraint-Induced Movement Therapies in chronic stoke focusing on the functional (i.e. motor recovery) and the neural (i.e. cortical organization) levels. [Results] Constraint-Induced Movement Therapies seemed to improve the upper limb functional usage in chronic stoke with no reliable neurophysiological underlying mechanisms. The Motor Activity Log was the common outcome measuring motor recovery. The work that has been done on modified Constraint-Induced Movement Therapy was far less than the work done on the original Constraint-Induced Movement Therapy. [Conclusion] Evident lack of understanding of the association between changes in motor recovery and the underlying neural mechanisms in-terms of measures of assessing and defining functional recovery (i.e Motor Activity Log) that lacks sufficient sensitivity to characterize changes in movement strategies and thereby lack of distinction between recovery and behavioral compensation. Future studies should employ using kinematic metrics to quantify and explain the training-related changes in behavior following Constraint-Induced Movement Therapies in chronic stroke.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Post-stroke motor recovery and cortical organization following Constraint-Induced Movement Therapies: a literature review

Bani-Ahmed

2019

J Phys Ther Sci

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“…For further details on the various forms of CI therapy including details of their protocols, results, and the nature of the modifications from the basic CI Movement therapy paradigm that enabled its broad application, the reader is referred to recent review articles (Taub and Uswatte, 2009; Uswatte and Taub, 2013) and to the data papers cited.…”

Section: Therapymentioning

confidence: 99%

The functional significance of cortical reorganization and the parallel development of CI therapy

Taub

Uswatte

Mark

2014

Front. Hum. Neurosci.

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For the nineteenth and the better part of the twentieth centuries two correlative beliefs were strongly held by almost all neuroscientists and practitioners in the field of neurorehabilitation. The first was that after maturity the adult CNS was hardwired and fixed, and second that in the chronic phase after CNS injury no substantial recovery of function could take place no matter what intervention was employed. However, in the last part of the twentieth century evidence began to accumulate that neither belief was correct. First, in the 1960s and 1970s, in research with primates given a surgical abolition of somatic sensation from a single forelimb, which rendered the extremity useless, it was found that behavioral techniques could convert the limb into an extremity that could be used extensively. Beginning in the late 1980s, the techniques employed with deafferented monkeys were translated into a rehabilitation treatment, termed Constraint Induced Movement therapy or CI therapy, for substantially improving the motor deficit in humans of the upper and lower extremities in the chronic phase after stroke. CI therapy has been applied successfully to other types of damage to the CNS such as traumatic brain injury, cerebral palsy, multiple sclerosis, and spinal cord injury, and it has also been used to improve function in focal hand dystonia and for aphasia after stroke. As this work was proceeding, it was being shown during the 1980s and 1990s that sustained modulation of afferent input could alter the structure of the CNS and that this topographic reorganization could have relevance to the function of the individual. The alteration in these once fundamental beliefs has given rise to important recent developments in neuroscience and neurorehabilitation and holds promise for further increasing our understanding of CNS function and extending the boundaries of what is possible in neurorehabilitation.

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“…The patients in the first CI therapy study 1 and in the early replications 3,14–16 had upper extremity motor deficits that could be characterized as mild/moderate (Grade 2 according to the categorization scheme employed here; see Table 1). A subsequent multi-site randomized clinical trial with a positive outcome 4 employed patients with mild/moderate and moderate motor deficits (Grades 2 and 3).…”

mentioning

confidence: 99%

Constraint-Induced Movement Therapy Combined With Conventional Neurorehabilitation Techniques in Chronic Stroke Patients With Plegic Hands: A Case Series

Taub

Uswatte

Bowman

et al. 2013

Archives of Physical Medicine and Rehabilitation

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Objective To determine in this pilot study whether the combination of CI therapy and conventional rehabilitation techniques can produce meaningful motor improvement in chronic stroke patients with initially fisted hands. In the past, limited success has been achieved using CI therapy alone for stroke patients with plegic hands. Design Case series Setting University hospital outpatient laboratory Participants Consecutive sample of 6 patients > 1 yr post-stroke with plegic hands Interventions Treatment consisted of an initial period of 3 weeks (Phase A) when adaptive equipment in the home, orthotics and splints were employed to improve ability to engage in activities of daily living. This was continued in Phase B, when CI therapy along with selected neurodevelopmental treatment techniques were added. Main Outcome Measures Motor Activity Log (MAL), accelerometry, Fugl-Meyer Motor Assessment (F-M) Results Patients exhibited a large improvement in spontaneous real-world use of the more-affected arm (mean lower-functioning MAL change = 1.3±0.4 points, P <0.001, d′ = 3.0), and a similar pattern of increase in an objective measure of real-world more-affected arm movement (mean change in ratio of more- to less-affected arm accelerometer recordings = 0.12±0.1 points, P = 0.016 d′ = 1.2). A large improvement in motor status was also recorded (mean F-M change = 5.3±3.3 points, P = 0.005, d′ = 1.6). Conclusions The findings of this pilot study suggest that stroke patients with plegic hands can benefit from CI therapy combined with some conventional rehabilitation techniques, even long after brain injury. More research is warranted.

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Constraint‐Induced Movement Therapy: A Paradigm for Translating Advances in Behavioral Neuroscience into Rehabilitation Treatments

Cited by 8 publications

References 148 publications

Post-stroke motor recovery and cortical organization following Constraint-Induced Movement Therapies: a literature review

Post-stroke motor recovery and cortical organization following Constraint-Induced Movement Therapies: a literature review

The functional significance of cortical reorganization and the parallel development of CI therapy

Constraint-Induced Movement Therapy Combined With Conventional Neurorehabilitation Techniques in Chronic Stroke Patients With Plegic Hands: A Case Series

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