Constraint-induced Therapy and the Motor Learning Literature That Underpins Its Application

Abstract

The influx in research to improve the evidence base and clinical effectiveness of existing practices has facilitated the emergence of new potential techniques. Constraint-induced therapy (CIT) is one such approach, used mostly widely in stroke rehabilitation. It focuses on the massed, random practice of functional tasks with the less able extremity, while the other is restrained. The evidence supporting the application of this technique is increasingly favourable, despite continued debate surrounding the optimal application. What remains scantly analysed are the underlying principles of CIT, to elucidate if massed, random practice of activities of daily living (ADLs) are the most suitable conditions to enhance learning. This paper helps to consolidate theoretically the advances made by existing clinical material. Although inhibiting initial performance, both massed and random practice provide greater learning potential. While further research is required, especially with these principles combined, this review concludes that CIT is based on the best available motor learning evidence, albeit the research has notable limitations.

Effects of Modified Constraint-Induced Movement Therapy on Movement Kinematics and Daily Function in Patients With Stroke: A Kinematic Study of Motor Control Mechanisms

“…2 Residual motor deficits in the UE and learned nonuse of the UE often lead to disability and permanent dependency on community care. 3 Constraint-induced movement therapy (CIMT) and modified CIMT (mCIMT) have been advocated as means to improve movement of the UE and functional use of the affected limb among patients post stroke. CIMT and mCIMT involve restraint of the unaffected limb for an extended period and repeated task-specific training of the affected limb.…”

“…The patients were right-hand dominant before stroke by self-report and were 12-36 months (mean, 18.07 months) post onset of a first-ever cerebrovascular accident. All patients received independent examinations by a physiatrist and occupational therapist to determine their eligibility for inclusion: (1) able to actively extend at least 10 degrees at the metacarpophalangeal and interphalangeal joints and 20 degrees at the wrist, (2) considerable nonuse of the more affected UE (amount-of-use score < 2.5 on the MAL 20 ), (3) no serious cognitive deficits (score ≥ 70 on the modified Mini-Mental State Exam 21 ), (4) no balance problems sufficient to compromise safety when wearing the study's constraint device, and (5) no excessive spasticity in any joint of the affected UE (shoulder, elbow, wrist, or fingers; Modified Ashworth Scale 22 ≤ 2 in any joint). Figure 1 shows how the patients were randomized to groups.…”

Potential Predictors of Motor and Functional Outcomes After Distributed Constraint-Induced Therapy for Patients With Stroke

“…1 Residual motor deficits in the UE frequently cause disability and permanent dependency on community care. 2 Constraintinduced therapy (CIT) has been advocated as means to improve motor recovery of the UE and functional use of the affected limb among patients after stroke. Constraint-induced therapy involves restraint of the unaffected UE (eg, during 90% of the hours the patient is awake per day for 2 weeks), forcing the use of the affected UE (eg, 6 h/d on 10 consecutive weekdays), and massed task-related training of the affected UE.…”

The Potential Predictors of Motor Performance Outcomes after Rehabilitation for Patients with Stroke

“…[1] Residual motor deficits in the UE frequently cause disability and permanent dependency on community care. [2] Rehabilitation programs have been advocated as means to improve motor recovery of the UE and functional use of the affected limb among patients after stroke. However, possible predictors related to motor outcome after rehabilitation remained unknown.…”