If it works in animals, why not humans?
If it works in animals, why not humans?
CI therapy results in functional improvements
The latest study showing the benefits of intense constraint-induced (CI) movement therapy builds on previous work that has established it as a successful treatment for chronic stroke patients who have lost function in one of their upper limbs.
The treatment is the result of years of research that showed animals undergo cortical reorganization after an injury to the nervous system. The studies found primates exhibited learned nonuse of an arm after a brain injury that affected that arm. However, when primates were forced to use the affected arm, they were able to do so. Because this worked with animals, it was theoretically possible that it could work with stroke patients, and that became the basis of the human research.
Various studies, including the latest published in the June 2000 issue of Stroke, have shown that patients who have lived with very little functional ability in one upper limb have regained their ability to move that limb after CI therapy, even if the therapy is administered many years post-stroke.1
With humans, it’s the intensity of the therapy that is the effective therapeutic factor, says Edward Taub, PhD, professor of psychology at the University of Alabama at Birmingham. Taub’s research led to the development of CI therapy. "We have a bag of tricks and use restraints, and that’s 20% of the treatment effect," he explains. "Then we have shaping and a variety of other techniques, but the basic effective factor is simply getting the patient to repeat movements over and over and over — behaviorally relevant movements and tasks."
The latest study caps a fairly substantial amount of research in this area, including a 1989 study showing how chronic stroke and head-injured patients have learned nonuse, which can be reversed through forced-use therapy. The earlier study documented significant changes among 25 chronic hemiplegic stroke and head-injured patients who had minimal to moderate upper-extremity extensor muscle function in performing 19 of 21 functional tasks. Those improvements persisted at a one-year follow-up.2
In a study published in Stroke last year, 15 chronic stroke patients were given CI therapy for 12 days. They showed a significant degree of improvement on a laboratory motor test and a test assessing the amount of use of the affected extremity in activities of daily living. There was no decline in performance at a six-month follow-up.3
Here are some details about the latest research:
• The study evaluated the reorganization, resulting from rehabilitation treatment, in the motor cortex of stroke patients.1
• There were 13 subjects with an age range of 33 to 73 years and a range of duration of hemiparesis of 0.5 to 18 years. Eleven of the subjects had a right-sided paresis. Ten had lacunar subcortical lesions involving the internal capsule, and three had cortical lesions.1
• The main inclusion criteria were that the patients had to be able to extend 20 degrees or greater at the wrist and 10 degrees at the fingers, and they needed sufficient stability to walk when their unaffected arm was immobilized. Patients with global aphasia or cognitive impairments that might interfere with their understanding instructions were excluded.1
• Subjects received 12 days of CI therapy and wore on the unaffected limb a resting hand splint secured in a sling for 90% of waking hours. They received electrophysiological, neurological, and behavioral testing.1
• Results were that the CI therapy produced a significant improvement in motor functions, according to a motor activity log. Also, transcranial magnetic stimulation mapping paralleled the behavioral results. The excitable cortex almost doubled, which yielded responses of a muscle in the more-affected hand of chronic stroke patients after CI therapy.1
References
1. Liepert J, Bauder H, Miltner WHR, et al. Treatment-induced cortical reorganization after stroke in humans. Stroke 2000; 31:1,210.
2. Wolf SL, Lecraw DE, Barton LA, Jann BB. Forced use of hemiplegic upper extremities to reverse the effect of learned nonuse among chronic stroke and head-injured patients. Exp Neurol 1989; 104:125-132.
3. Miltner WHR, Bauder H, Sommer M, et al. Effects of constraint-induced movement therapy on patients with chronic motor deficits after stroke. Stroke 1999; 30:586-592.
Need More Information?
American Heart Association, publisher of Stroke, 7272 Greenville Ave., Dallas, TX 75231-4599. Phone: (214) 706-1396. A copy of "Treatment-Induced Cortical Reorganization After Stroke in Humans" is available on the AHA Web site: www.americanheart.org. Link to the journal page and click on the June 2000 issue. It costs $5 for nonsubscribers to download the article and accompanying literature.
Edward Taub, PhD, Professor of Psychology, University of Alabama at Birmingham, Department of Psychology, CH415, 1530 3rd Ave. S., Birmingham, AL 35294-1170. For details on the private-pay CI therapy clinic, call (205) 934-4966.
Gregory del Zoppo, MD, Associate Professor, Department of Molecular and Experimental Medicine, The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, CA 92037. Phone: (858) 784-8569.
Judith Schaechter, PhD, MSPT, Assistant Professor, Department of Physical Therapy, Northeastern University, 6 Robinson Hall, 360 Huntington Ave., Boston, MA 02115. Phone: (617) 373-5012.
Martin Schaeffer, MD, Medical Director, Department of Physical Medicine and Rehabilitation, DuBois Regional Medical Center, 145 Hospital Ave., Suite 300, DuBois, PA 15801. Phone: (814) 375-4660.
Lori-Ann Pietruski, OT, OTR-L, Brooks Rehabilitation Hospital, 3599 University Blvd. S., Jacksonville, FL 32216. Phone: (904) 858-7600, ext. 4726.
Donni Welch-Rawls, MS-PT, Manager of Physical Therapy, Brooks Rehab Hospital, 3599 University Blvd. S., Jacksonville, FL 32216. Phone: (904) 858-7641.
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.