in anyone have information about contrained movement therapy

[piyushmadani]

hi physio friends,
i would like to know more about constrained movement therapy for improving hand function in hemiplegia( less than 6 mths).

if anyone know about this, refer some books, sites or relevant links do mail me

with thanks


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[Clarktangent]

I would like to know that too. e-mail me thru [email protected]

[sdkashif]

Constraint-induced movement therapy (CIT) is a family of therapies that induce patients who have had a stroke to greatly increase the amount and quality of movement of their paretic limb, in turn improving function. CIT is based on the theory of "learned nonuse," first described by Wolf and later by Taub. Following substantial neurological injury, a shocklike phenomenon, called diaschisis, results in a dramatically depressed condition of motor neuron function. During this shock period, the patient is unable to move the affected limb and subsequently learns to compensate with the functional limb. As the shock resolves and function starts to improve, attempts to use the affected limb result in clumsy and ineffective movements that positively reinforce continued compensation.

Treatment begins by restraining the functional limb during all waking hours, except for specified activities, and then forcing the patient to perform tasks almost exclusively with their paretic limb for up to 2 weeks. This usually produces measurable improvement of function in the paretic limb, as well as increases in speed and strength of contraction, provided some selective hand movement (slight wrist and finger extension), good balance, and good cognitive and communication skills are present.

As reported by Morris, a behavioral training technique called shaping often is used in conjunction with CIT. Shaping has resulted in substantial improvement of motor function. Shaping approaches a desired motor outcome in small successive steps through explicit positively reinforced feedback by the therapist. This allows subjects to experience successful gains in performance with relatively small amounts of motor improvement. A battery of approximately 60 tasks has been developed with a preliminary shaping plan for each task. Each task can be broken down into subtasks. Performance regressions are never punished and usually are ignored. If performance continues to exhibit no improvement after approximately 3 trials, the subject is encouraged to improve further at a later time, a simpler subtask is attempted, or an entirely different task is substituted. Eventually, an individualized task-oriented home program that emphasizes the use of the most impaired movements and joints is established.

Patients tend to reach a plateau in motor recovery within 6-12 months following stroke. Compared to an attention-comparison group, the restrained subjects improved on each measure of motor function (ie, performance time, quality of movement, range of activities); in most cases, patients improved markedly. Two-year follow-up revealed that ADL functions had been maintained or increased. The use of CIT proved to be an effective means of restoring substantial motor function in chronic stroke patients.

See Constraint Induced movement Therapy

Reference:

Morris DM: Constraint-Induced Movement Therapy for Motor Recovery After Stroke. NeuroRehabil 1997

[somasimple]

Actually the results aren't so good and this kind of therapy has no real future.