Constraint-induced movement therapy for recovery of upper-limb function following traumatic brain injury

Shaw, S; Morris, David; Uswatte, Gitendra; McKay, Staci; Meythaler, Jay M.; Taub, Edward

doi:10.1682/jrrd.2005.06.0094

Cited by 92 publications

(76 citation statements)

References 40 publications

(56 reference statements)

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“…Patients with TBI have been shown to have positive rehabilitation outcomes as a result of high numbers of functional reps, such as is required in constraint-induced movement therapy (CIMT) [20]. Patients with TBI who received additional functional reps (+160 reps of sit-tostand and step-ups) had a larger functional improvement compared with a group who did not receive the additional reps, suggesting that the dose of rehabilitation is also important in TBI [21].…”

Section: Introductionmentioning

confidence: 99%

Comparison of amounts and types of practice during rehabilitation for traumatic brain injury and stroke

Kimberley¹,

Samargia²,

Moore³

et al. 2010

JRRD

117

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Abstract-Patients with acquired neurological deficits may capitalize on cortical reorganization to recover functional skills that have been lost. Research in neuroplasticity proposes that a high number of repetitions may lead to cortical reorganization. The purposes of this study were to quantify the number and type of activities performed by patients with traumatic brain injury (TBI) and stroke in physical and occupational therapy sessions to determine whether (1) the number of repetitions approaches the numbers in neuroplasticity research, (2) there were differences based on patient diagnosis, and (3) patient or therapist characteristics affected the type or amount of activities performed. Forty-eight patient and forty provider subjects participated. One hundred seven therapy sessions were observed. Data from therapy sessions were counted and categorized. Neither patient group approached the total number of repetitions neuroplasticity research suggests may be required for neuroplastic change. Repetitions per session did not differ between groups. Subjects with TBI performed more repetitions per minute in three categories (total upper-limb repetitions, gait steps, and transfers) than subjects with stroke. Therapists with <1 year or >15 years of neurological therapy experience instructed patients in fewer functional repetitions per minute than did therapists with 5 to 15 years of experience.

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Section: Introductionmentioning

confidence: 99%

Comparison of amounts and types of practice during rehabilitation for traumatic brain injury and stroke

Kimberley¹,

Samargia²,

Moore³

et al. 2010

JRRD

117

View full text Add to dashboard Cite

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“…In some cases, the CIMT achieved voluntary purposeful behavior consistent with presurgical limb function, providing further support for Taub's hypothesis of learned nonuse. While early human clinical research focused on the use of CIMT following stroke [20,25], a series of internationally funded scientific studies subsequently demonstrated applicability following other traumas, including upper limbs after TBI, lower limbs after stroke, spinal cord injury, fractured hip, and aphasia after stroke [32][33][34][35][36][37].…”

Section: Resultsmentioning

confidence: 99%

“…These include the differential control of electroencephalography to reduce medically unresponsive epileptic seizures [57][58] and other conditions [59], as well as the aforementioned training and recovery of affected limbs following stroke [3], the upper limbs after TBI, the lower limbs after stroke, spinal cord injury, fractured hip, and aphasia after stroke [33][34][35][36][37]. What has also been demonstrated is that the presence of verbal report or lack of memory does not determine whether voluntary control of physiological response can be trained.…”

Section: Resultsmentioning

confidence: 99%

Absence of verbal recall or memory for symptom acquisition in fear and trauma exposure: A conceptual case for fear conditioning and learned nonuse in assessment and treatment

Ar¹

2012

JRRD

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Abstract-Absence of memory or verbal recall for symptom acquisition in fear and trauma exposure, as well as absence of successful coping behavior for life events, is associated with a number of diagnoses, including traumatic brain injury, posttraumatic stress disorder, pain, and anxiety. The difficulty with diagnosis and treatment planning based on the absence of recall, memory, and successful coping behavior is threefold: (1) these assessments do not distinguish between disruption of behavior and lack of capacity, (2) the absence of verbal recall and memory complicates cognitive-based treatment, and (3) a confounding issue is the same absent behavior can be observed at different times and contexts. While memory of the specific details of the initial traumatic event(s) may not be available to verbal report, the existence of time-and context-dependent relationships for the initial as well as subsequent experiences is arguable. The absence of memory or lack of verbal recall does not rule out measurable physiological bodily responses for the initial trauma(s), nor does it help to establish the effects of subsequent experiences for symptom expression. Also, the absence of memory must include the prospect of fear-based learning that does not require or involve the cortex. It is posited that the literatures of fear conditioning and learned nonuse provide complementary illustrations of how the time and context of the initial trauma(s) and subsequent experiences affect behavior, which is not dependent on the effected individual being able to provide a memory-based verbal report. The replicated clinical application demonstrates that, without scientific demonstration, neither neuroanatomy nor verbal report can be assumed sufficient to predict overt behavior or physiologic responses. For example, while commonly assumed to be predictively so, autonomic nervous system innervation is insufficient to define the unique stimulus-and context-dependent physiological responses of an individual. By recording simultaneous physiological responses to the controlled presentation of a context-dependent stimulus, the unique relationships of physiology and overt behaviors for the individual can be demonstrated. Using this process also allows more complex virtual reality or other in vivo stimulus assessments to be incorporated for the development of individually tailored assessments and therapeutic plans. Thus, with or without memory or verbal recall, the use of multiple time-and context-specific simultaneous physiological measures and overt behavior can guide clinical effort as well as serve to objectively assess the ongoing treatment and its outcome.Key words: anxiety, context learning, fear conditioning, learned nonuse, memory, pain, physiology, posttraumatic stress disorder, traumatic brain injury, verbal recall.Abbreviations: ANS = autonomic nervous system, CBT = cognitive behavioral therapy, CIMT = constraint-induced movement therapy, CR = conditioned response, PNS = parasympathetic nervous system, PTSD = posttraumatic stress disorder...

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“…Evidence supports the general effectiveness of physical rehabilitation in improving TBI outcomes (Bland, Zampieri-Gallagher, and Damiano, 2011;Betker, Desai, Nett, Kapadia, and Szturm, 2007;Irdesel, Aydiner, and Akgoz, 2007;Mossberg, Amonette, and Masel, 2010;Scherer and Schubert, 2009;Shaw et al, 2005). Persons who have little or no response to stimulation (i.e., comatose, vegetative or minimally conscious state) benefit from activities that prevent involuntary muscle contraction or muscle shortening and skin breakdown.…”

Section: Effectiveness Of Physical Rehabilitationmentioning

confidence: 94%

Prospective study of myelin water fraction changes after mild traumatic brain injury in collegiate contact sports

Spader

Dean

LaFrance

et al. 2019

Journal of Neurosurgery

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OBJECTIVEMild traumatic brain injury (mTBI) in athletes, including concussion, is increasingly being found to have long-term sequelae. Current imaging techniques have not been able to identify early damage caused by mTBI that is predictive of long-term symptoms or chronic traumatic encephalopathy. In this preliminary feasibility study, the authors investigated the use of an emerging magnetic resonance imaging (MRI) technique, multicomponent driven equilibrium single pulse observation of T1 and T2 (mcDESPOT), in visualizing acute and chronic white matter changes after mTBI in collegiate football and rugby players.METHODSThis study was a nonrandomized, nonblinded prospective trial designed to quantify changes in the myelin water fraction (MWF), used as a surrogate MRI measure of myelin content, in a group of male collegiate football and rugby players, classified here as a contact sport player (CSP) cohort, at the time of mTBI diagnosis and 3 months after injury when the acute symptoms of the injury had resolved. In addition, differences in the MWF between the CSP cohort and a control cohort of noncontact sport players (NCSPs) were quantified. T-tests and a threshold-free cluster enhancement (TFCE) statistical analysis technique were used to identify brain structures with significant changes in the MWF between the CSP and NCSP cohorts and between immediately postinjury and follow-up images obtained in the CSP cohort.RESULTSBrain MR images of 12 right-handed male CSPs were analyzed and compared with brain images of 10 right-handed male NCSPs from the same institution. A comparison of CSP and NCSP baseline images using TFCE showed significantly higher MWFs in the bilateral basal ganglia, anterior and posterior corpora callosa, left corticospinal tract, and left anterior and superior temporal lobe (p < 0.05). At the 3-month follow-up examination, images from the CSP cohort still showed significantly higher MWFs than those identified on baseline images from the NCSP cohort in the bilateral basal ganglia, anterior and posterior corpora callosa, and left anterior temporal lobe, and also in the bilateral corticospinal tracts, parahippocampal gyrus, and bilateral juxtapositional (previously known as supplemental motor) areas (p < 0.05). In the CSP cohort, a t-test comparing the MWF at the time of injury and 3 months later showed a significant increase in the overall MWF at follow-up (p < 0.005). These increases were greatest in the bilateral basal ganglia and deep white matter. MWF decreases were seen in more superficial white matter (p < 0.005).CONCLUSIONSIn this preliminary study, MWF was found to be increased in the brains of CSPs compared with the brains of controls, suggesting acute/chronic MWF alterations in CSPs from previous injuries. Increases in the MWF were also demonstrated in the brains of CSPs 3 months after the players sustained an mTBI. The full clinical significance of an increased MWF and whether this reflects axon neuropathology or disorderly remyelination leading to hypermyelination has yet to be determined.

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Constraint-induced movement therapy for recovery of upper-limb function following traumatic brain injury

Cited by 92 publications

References 40 publications

Comparison of amounts and types of practice during rehabilitation for traumatic brain injury and stroke

Comparison of amounts and types of practice during rehabilitation for traumatic brain injury and stroke

Absence of verbal recall or memory for symptom acquisition in fear and trauma exposure: A conceptual case for fear conditioning and learned nonuse in assessment and treatment

Prospective study of myelin water fraction changes after mild traumatic brain injury in collegiate contact sports

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