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Constraint-Induced Movement Therapy

Excerpted from the article, "A Rehab Revolution," Stroke Connection Magazine, September/October 2004
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Constraint-induced movement therapy (CI) forces the use of the affected side by restraining the unaffected side. With CI therapy, the therapist constrains the survivor’s unaffected arm in a sling. The survivor then uses his or her affected arm repetitively and intensively for two weeks.

Dr. Edward Taub, a professor of psychology at the University of Alabama in Birmingham, developed CI therapy. He says that after a stroke, a survivor tries unsuccessfully to use the affected side. Their initial failure discourages them from using that side. Dr. Taub calls this “learned non-use.”

After her stroke in 1999, Reva Baughman, 61, of La Crescenta, Calif., could hardly lift her left arm or move her fingers. This year, she underwent CI therapy at the Advanced Recovery Rehab Center in Sherman Oaks, Calif. Therapy lasted six hours a day, five days a week, for three weeks.

Today she can raise her arm, hold a bottle steady in her hand and feed herself sandwiches and cookies with her left hand. “Before CI therapy, I did not even try to use my affected hand and arm,” she says. “Now I try new things every day with my left arm and hand. I have the impetus to try.”

In order to use CI therapy, survivors need to be able to extend their wrists and move their arm and fingers. Numerous small studies show CI therapy improves movement on the affected side. A June 2000 study published in Stroke: Journal of the American Heart Association also showed that brain activity actually improves with the treatment. 

“This finding offers hope to researchers who believe it may be possible to stimulate or manipulate brain areas to take over lost functions, a process known as cortical reorganization,” says Dr. Taub.

Currently, researchers are studying whether CI therapy improves arm and shoulder movement three-to-six months after stroke and if the gains last over a period of two years.

At this time, medical insurance does not reimburse for CI therapy. It costs about $5,000 for two weeks of treatment.

2006 Update 

Constraint-induced movement therapy (CIMT) has really taken off in the past two years. Dr. Edwin Taub’s ideas of “learned non-use” and intensive use of the affected side have been at the forefront of a revolution in what it is possible for stroke survivors to recover. In 2004, Dr. Taub’s three principles of constraining the unaffected limb, forced use of the affected limb and massed practice showed great promise, but the protocol lacked placebo-controlled verification.

Recently Dr. Taub, of the University of Alabama at Birmingham, led a team to do exactly that. Researchers studied survivors with mild to moderate motor impairment of an upper limb, an average of 4.5 years after stroke.  Twenty-one survivors (average age 55) underwent Constraint-Induced Movement Therapy: six intensive hours a day for 10 consecutive weekdays.  Twenty survivors (average age 51) had placebo therapy – a general fitness program of strength, balance and stamina training, games to provide cognitive challenges and relaxation exercises for six hours a day for 10 consecutive weekdays.

CIMT patients showed “large to very large” improvements in the functional use of their affected arm in their daily lives. Scores on a motor activity log (MAL) in which survivors and caregivers noted how well and how much survivors used their impaired arm in daily living improved an average of 1.8 points for those undergoing CIMT.  Those in the control group reported no change.  In addition, CIMT patients were able to speed their completion of tasks in lab testing while the placebo patients were slower.

At two-year follow-up, the CIMT group showed a large improvement in MAL scores compared to pre-treatment scores.  Those in the placebo group displayed no significant changes.  

In 2004, few rehab facilities offered CIMT; today, CIMT is increasingly common because it has proven effective at improving survivors’ lives.

 



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