Purpose: To investigate the use of constraint-induced movement therapy (CIMT) in Canadian neurological occupational and physical therapy. Method: An online survey was completed by occupational and physical therapists practising in Canadian adult neurological rehabilitation. We measured participants' practices, perceptions, and opinions in relation to their use of CIMT in clinical practice. Results: A total of 338 surveys were returned for a 13% response rate; 92% of respondents knew of CIMT, and 43% reported using it. The majority (88%) of respondents using CIMT employed a non-traditional protocol. Self-rating of level of CIMT knowledge was found to be a significant predictor of CIMT use (p a 0.001). Commonly identified barriers to use included ''patients having cognitive challenges that prohibit use of this treatment'' and ''lack of knowledge regarding treatment.'' Conclusions: Although the majority of respondents knew about CIMT, less than half reported using it. Barriers to CIMT use include lack of knowledge about the treatment and institutional resources to support its use. Identifying and addressing barriers to CIMT use-for example, by using continuing professional education to remediate knowledge gaps or developing new protocols that require fewer institutional resources-can help improve the feasibility of CIMT, and thus promote its clinical application.Key Words: constraint-induced movement therapy; rehabilitation; stroke; surveys; upper extremity. RÉ SUMÉObjectif : É tudier l'utilisation de la thé rapie par le mouvement par contrainte induite (TMCI) en ergothé rapie et en physiothé rapie neurologiques au Canada. Mé thode : Des ergothé rapeutes et des physiothé rapeutes pratiquant dans le secteur de la ré adaptation neurologique des adultes au Canada ont ré pondu à un questionnaire en ligne. Nous avons mesuré les pratiques des participants, leurs perceptions et leurs opinions au sujet de leur utilisation de la TMCI en pratique clinique. Ré sultats : Au total, 338 questionnaires ont é té renvoyé s, ce qui donne un taux de ré ponse de 13 %; 92 % des ré pondants connaissaient la TMCI et 43 % ont dé claré l'utiliser. Les ré pondants utilisant la TMCI suivaient en majorité (88 %) un protocole non traditionnel. On a constaté que l'autoé valuation du niveau de connaissance de la TMCI constituait un pré dicteur important de l'utilisation de la thé rapie (p a 0,001). Les obstacles à l'utilisation mentionné s couramment incluaient « le fait que des patients ont des problè mes de cognition qui empê chent d'utiliser le traitement » et « le manque de connaissance du traitement ». Conclusions : Mê me si la majorité des ré pondants connaissait la TMCI, moins de la moitié a dé claré l'utiliser. Les obstacles à l'utilisation de la TMCI comprennent le manque de connaissance du traitement et de ressources institutionnelles pour en appuyer l'utilisation. La dé termination et l'é limination des obstacles à l'utilisation de la TMCI-par exemple, en recourant à l'enseignement supé rieur professionnel continu pour corrige...

The mCIMT protocol is an effective intervention for UE recovery post stroke. Future research including large RCTs could potentially increase the LOE for mCIMT. Additional investigation into the effectiveness of mCIMT in acute and subacute stroke populations is warranted given the limited number of studies performed to date.

Objectives To determine the reliability and validity of the Modified Heckmatt scale in assessing muscle echotexture in spasticity. Design Prospective, observational, 2-center study. Two residents and 2 ultrasound experienced staff physicians each rated 100 ultrasound images that were also analyzed using quantitative gray-scale. Setting Academic ambulatory spasticity clinic. Participants Participants (N=50) included 45 patients with upper or lower extremity spasticity and 5 healthy references. Interventions Not applicable. Main Outcome Measures Modified Heckmatt scale ratings and quantitative gray-scale scores Results Inter- and intra-rater intraclass correlation coefficients were 0.76 and 0.81, respectively ( P <.001), indicating good to excellent reliability. A significant relationship was found between Modified Heckmatt scores and quantitative gray-scale scores ( r =0.829; P <.001). Conclusions The Modified Heckmatt scale demonstrated good reliability and validity to assess the pathologic muscle changes that occur in patients with spasticity.

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