scholarly journals Revisiting Constraint-Induced Movement Therapy: Are We Too Smitten With the Mitten? Is All Nonuse “Learned”? and Other Quandaries

2007 ◽  
Vol 87 (9) ◽  
pp. 1212-1223 ◽  
Author(s):  
Steven L Wolf
Keyword(s):  
Upper Extremity ◽  
Movement Therapy ◽  
Detailed Model ◽  
Constraint Induced Movement Therapy ◽  
Scientific Exploration ◽  
Critical Issues ◽  
Valuable Treatment ◽  
Impaired Limb ◽  
Task Practice ◽  
Task Oriented

Constraint-induced movement therapy (CIMT) has gained considerable popularity as a valuable treatment for a hemiparetic upper extremity. This approach is compatible with the emerging notion that task-oriented or functionally oriented retraining of the impaired limb provides evidence to support its utility. This article first provides a historical perspective on the development of CIMT. An overview model of how learned nonuse of the hemiparetic limb occurs and can be overcome with CIMT is discussed, and then a more detailed model that incorporates critical issues requiring considerably more basic and applied scientific exploration is described. Among the issues considered are the extent to which hemiparetic limb nonuse and subsequent modes of delivery to overcome it are governed by structure-function deficits rather than being attributable primarily to behavioral phenomena; the relative importance of the intensity of training; the need to better balance unimanual and bimanual upper-extremity task practice; the role of psychosocial and cultural factors in fostering patient compliance; the optimization of modes of delivery; and the reevaluation of the constellation of components contributing to successful outcomes with this treatment. Finally, the strengths, uncertainties, and limitations associated with CIMT are examined.

scholarly journals Application of Constraint-Induced Movement Therapy for an Individual With Severe Chronic Upper-Extremity Hemiplegia

2003 ◽  
Vol 83 (4) ◽  
pp. 384-398 ◽  
Author(s):  
Nancy (McNamara) Bonifer ◽  
Kristin M Anderson
Keyword(s):  
Case Report ◽  
Motor Activity ◽  
Upper Extremity ◽  
Motor Function ◽  
Movement Therapy ◽  
Motor Deficits ◽  
Intensive Training ◽  
Constraint Induced Movement Therapy ◽  
Task Practice

Abstract Background and Purpose. Constraint-induced movement therapy (CIMT) has been documented to improve motor function in the upper extremity of people with mild hemiparesis. The use of CIMT has not been documented for people with severe hemiparesis. This case report describes a CIMT program for an individual with severe upper-extremity deficits as a result of stroke. Case Description. The client was a 53-year-old woman who had a stroke 15 years previously and had no isolated movement in her right upper extremity. Methods. The client completed a 3-week CIMT program during which she restrained her left upper extremity and participated in intensive training of her right upper extremity. Task practice and shaping were the primary techniques used for training. Outcomes. Increased scores were noted from pretreatment to posttreatment on the Motor Activity Log, Graded Wolf Motor Function Test (GWMFT), and Fugl-Meyer Evaluation of Physical Performance. Further progress on the GWMFT was noted at the 6-month follow-up. Fugl-Meyer test scores remained higher than at pretreatment, but Motor Activity Log scores returned to near baseline by the 6-month follow-up. The speed of performance on the GWFMT did not change. Although some scores increased, the client reported and demonstrated no progress in functional use of the involved upper extremity at the end of the program. Discussion. This case report describes the use of CIMT with an individual who had severe chronic motor deficits as a result of stroke. Further investigation of CIMT, as well as investigation of CIMT in combination with other motor recovery interventions, is warranted.

scholarly journals Efficacy of Constraint-Induced Movement Therapy for Post-Stroke Upper Extremity Hemiparesis Patients Attending a Day-Care Center

2009 ◽  
Vol 24 (6) ◽  
pp. 929-933
Author(s):  
Taichi KURAYAMA ◽  
Anna WATANABE ◽  
Minami TAKAMOTO ◽  
Nami SHIGETA ◽  
Yuki HASEGAWA ◽  
...  
Keyword(s):  
Upper Extremity ◽  
Day Care ◽  
Care Center ◽  
Movement Therapy ◽  
Day Care Center ◽  
Post Stroke ◽  
Constraint Induced Movement Therapy

scholarly journals Predicting Improved Daily Use of the More Affected Arm Poststroke Following Constraint-Induced Movement Therapy

2019 ◽  
Vol 99 (12) ◽  
pp. 1667-1678 ◽  
Author(s):  
Mohammad H Rafiei ◽  
Kristina M Kelly ◽  
Alexandra L Borstad ◽  
Hojjat Adeli ◽  
Lynne V Gauthier
Keyword(s):  
Motor Activity ◽  
Retrospective Analysis ◽  
Upper Extremity ◽  
Probabilistic Neural Network ◽  
Movement Therapy ◽  
Individual Characteristics ◽  
Study Objective ◽  
Machine Learning Classification ◽  
Constraint Induced Movement Therapy ◽  
Ci Therapy

Abstract Background Constraint-induced movement therapy (CI therapy) produces, on average, large and clinically meaningful improvements in the daily use of a more affected upper extremity in individuals with hemiparesis. However, individual responses vary widely. Objective The study objective was to investigate the extent to which individual characteristics before treatment predict improved use of the more affected arm following CI therapy. Design This study was a retrospective analysis of 47 people who had chronic (> 6 months) mild to moderate upper extremity hemiparesis and were consecutively enrolled in 2 CI therapy randomized controlled trials. Methods An enhanced probabilistic neural network model predicted whether individuals showed a low, medium, or high response to CI therapy, as measured with the Motor Activity Log, on the basis of the following baseline assessments: Wolf Motor Function Test, Semmes-Weinstein Monofilament Test of touch threshold, Motor Activity Log, and Montreal Cognitive Assessment. Then, a neural dynamic classification algorithm was applied to improve prognostic accuracy using the most accurate combination obtained in the previous step. Results Motor ability and tactile sense predicted improvement in arm use for daily activities following intensive upper extremity rehabilitation with an accuracy of nearly 100%. Complex patterns of interaction among these predictors were observed. Limitations The fact that this study was a retrospective analysis with a moderate sample size was a limitation. Conclusions Advanced machine learning/classification algorithms produce more accurate personalized predictions of rehabilitation outcomes than commonly used general linear models.

scholarly journals Constraint-Induced Movement Therapy (CIMT): Current Perspectives and Future Directions

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Aimee P. Reiss ◽  
Steven L. Wolf ◽  
Elizabeth A. Hammel ◽  
Erin L. McLeod ◽  
Erin A. Williams
Keyword(s):  
Comparative Study ◽  
Upper Extremity ◽  
Movement Therapy ◽  
Practical Approach ◽  
Treatment Technique ◽  
Review Of Literature ◽  
Substantial Evidence ◽  
Future Directions ◽  
Constraint Induced Movement Therapy ◽  
Upper Extremity Rehabilitation

Constraint-induced movement therapy (CIMT) has gained considerable popularity as a treatment technique for upper extremity rehabilitation among patients with mild-to-moderate stroke. While substantial evidence has emerged to support its applicability, issues remain unanswered regarding the best and most practical approach. Following the establishment of what can be called the “signature” CIMT approach characterized by intense clinic/laboratory-based practice, several distributed forms of training, collectively known as modified constraint therapy (mCIMT), have emerged. There is a need to examine the strengths and limitations of such approaches, and based upon such information, develop the components of a study that would compare the signature approach to the best elements of mCIMT, referred to here as “alternative” CIMT. Based upon a PEDro review of literature, limitations in mCIMT studies for meeting criteria were identified and discussed. A suggestion for a “first effort” at a comparative study that would both address such limitations while taking practical considerations into account is provided.

scholarly journals An Application of Upper-Extremity Constraint-Induced Movement Therapy in a Patient With Subacute Stroke

1999 ◽  
Vol 79 (9) ◽  
pp. 847-853 ◽  
Author(s):  
Sarah Blanton ◽  
Steven L Wolf
Keyword(s):  
Upper Extremity ◽  
Motor Function ◽  
Internal Capsule ◽  
Movement Therapy ◽  
Self Report ◽  
Full Potential ◽  
Posterior Limb ◽  
Constraint Induced Movement Therapy ◽  
Subacute Stroke

Abstract Background and Purpose. The purpose of this case report is to demonstrate the application of constraint-induced movement therapy with an individual with upper-extremity hemiparesis within 4 months after sustaining a cerebrovascular accident (stroke). Such patients often fail to develop full potential use of their affected upper extremity, perhaps due to a “learned nonuse phenomenon.” Case Description. The patient was a 61-year-old woman with right-sided hemiparesis resulting from an ischemic lacunar infarct in the posterior limb of the left internal capsule. The patient's less-involved hand was constrained in a mitten so that she could not use the hand during waking hours, except for bathing and toileting. On each weekday of the 14-day intervention period, the patient spent 6 hours being supervised while performing tasks using the paretic upper extremity. Pretreatment, posttreatment, and 3-month follow-up outcome measures included the Wolf Motor Function Test and the Motor Activity Log (MAL). Outcomes. For the Wolf Motor FunctionTest, both the mean and median times to complete 16 tasks improved from pretreatment to posttreatment and from posttreatment to follow-up. Results of the MAL indicated an improved self-report of both “how well” and “how much” the patient used her affected limb in 30 specified daily tasks. These improvements persisted to the follow-up. Discussion. Two weeks of constraining the unaffected limb, coupled with practice of functional movements of the impaired limb, may be an effective method for restoring motor function within a few months after cerebral insult. Encouraging improvements such as these strongly suggest the need for a group design that would explore this type of intervention in more detail.

Sign in / Sign up

Export Citation Format

Share Document