Effect of Forced Use of the Affected Upper Extremity of a Subject 19 Months Post-CVA

Foster, L; Murphy, Kevin P.; Nicholson, Barbara; Ruff, E; Forsyth, LeighAnn H.

doi:10.1097/01253086-199620040-00030

Cited by 2 publications

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“…Studies that have used attenuated (Butefisch et al, 1995; Foster et al, 1996; Peter and Leidner, 1997; Van der Lee et al, 1999; Dromerick et al, 2000; Charles et al, 2001; Gritsenko et al, 2001; Johnson et al, 2001; Kedlaya et al, 2001; Liepert et al, 2001; Platz et al, 2001) or partial versions (Ince, 1969; Halberstam et al, 1971; Ostendorf and Wolf, 1981; Wolf et al, 1989) of the full protocol have reported positive results but had smaller gains than the two RCTs from our laboratory. The usual missing component was the transfer package (TP, described below).…”

Section: Therapymentioning

confidence: 99%

“…These results have been confirmed in a large, multisite randomized clinical trial (RCT) in patients 3-9 months after stroke, i.e., the EXCITE trial (Wolf et al, 2006 , 2008 ), and several hundred other smaller studies (Langhorne et al, 2009 ; Stevenson et al, 2012 ). Studies that have used attenuated (Butefisch et al, 1995 ; Foster et al, 1996 ; Peter and Leidner, 1997 ; Van der Lee et al, 1999 ; Dromerick et al, 2000 ; Charles et al, 2001 ; Gritsenko et al, 2001 ; Johnson et al, 2001 ; Kedlaya et al, 2001 ; Liepert et al, 2001 ; Platz et al, 2001 ) or partial versions (Ince, 1969 ; Halberstam et al, 1971 ; Ostendorf and Wolf, 1981 ; Wolf et al, 1989 ) of the full protocol have reported positive results but had smaller gains than the two RCTs from our laboratory. The usual missing component was the transfer package (TP, described below).…”

Section: Therapymentioning

confidence: 99%

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The functional significance of cortical reorganization and the parallel development of CI therapy

Taub

Uswatte

Mark

2014

Front. Hum. Neurosci.

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For the nineteenth and the better part of the twentieth centuries two correlative beliefs were strongly held by almost all neuroscientists and practitioners in the field of neurorehabilitation. The first was that after maturity the adult CNS was hardwired and fixed, and second that in the chronic phase after CNS injury no substantial recovery of function could take place no matter what intervention was employed. However, in the last part of the twentieth century evidence began to accumulate that neither belief was correct. First, in the 1960s and 1970s, in research with primates given a surgical abolition of somatic sensation from a single forelimb, which rendered the extremity useless, it was found that behavioral techniques could convert the limb into an extremity that could be used extensively. Beginning in the late 1980s, the techniques employed with deafferented monkeys were translated into a rehabilitation treatment, termed Constraint Induced Movement therapy or CI therapy, for substantially improving the motor deficit in humans of the upper and lower extremities in the chronic phase after stroke. CI therapy has been applied successfully to other types of damage to the CNS such as traumatic brain injury, cerebral palsy, multiple sclerosis, and spinal cord injury, and it has also been used to improve function in focal hand dystonia and for aphasia after stroke. As this work was proceeding, it was being shown during the 1980s and 1990s that sustained modulation of afferent input could alter the structure of the CNS and that this topographic reorganization could have relevance to the function of the individual. The alteration in these once fundamental beliefs has given rise to important recent developments in neuroscience and neurorehabilitation and holds promise for further increasing our understanding of CNS function and extending the boundaries of what is possible in neurorehabilitation.

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Section: Therapymentioning

confidence: 99%

Section: Therapymentioning

confidence: 99%

The functional significance of cortical reorganization and the parallel development of CI therapy

Taub

Uswatte

Mark

2014

Front. Hum. Neurosci.

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“…massing of practice or repetitive training) and, less importantly, restrain-ing the less-affected hand in a protective safety mitt or the entire arm in a sling for a target of 90% of waking hours during the treatment period. Using one portion or the other of the full treatment regimen (5)(6)(7)(8)(9), or both components (10)(11)(12)(13)(14), or an attenuated version of the procedure (15)(16)(17)(18)(19)(20), investigators in other laboratories have also obtained positive results with patients after stroke. An authoritative literature review (21) stemming from an NIH consensus conference cites CI therapy as being only one of three treatments for which there is evidence of clinical efficacy and the only one to: 1) be supported with evidence from controlled randomized studies, and 2) have been shown to be effective for the upper extremity.…”

Section: Introductionmentioning

confidence: 99%

Constraint-induced movement therapy: bridging from the primate laboratory to the stroke rehabilitation laboratory

Taub

Uswatte²

2003

Journal of Rehabilitation Medicine

110

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In this laboratory we have developed a set of techniques that randomized controlled studies indicate can substantially reduce the motor deficit of patients with mild to moderately severe chronic strokes. The techniques, termed Constraint-Induced Movement therapy (CI therapy), involve motor restriction of the less-affected arm while at the same time intensively training the more-affected arm. The intervention was derived directly from basic research with monkeys. The primary difference between CI therapy and conventional physical therapy is in the duration and intensity of the treatment. The greatly improved extremity function produced in the laboratory transfers to the activities of daily living outside the clinic. Treatment gains persisted for the two years tested. Converging data from seven experiments has shown that CI therapy produces massive alterations in brain organization and function correlated with the large improvements in motor ability that it produces.

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Effect of Forced Use of the Affected Upper Extremity of a Subject 19 Months Post-CVA

Cited by 2 publications

References 0 publications

The functional significance of cortical reorganization and the parallel development of CI therapy

The functional significance of cortical reorganization and the parallel development of CI therapy

Constraint-induced movement therapy: bridging from the primate laboratory to the stroke rehabilitation laboratory

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