Posts Tagged constraint induced movement therapy

[WEB SITE] Constraint Induced Movement Therapy

WHAT IS CIMT?

taub2Constraint-Induced Movement therapy (CIMT/ CIT) or CI therapy is a new therapeutic approach to rehabilitation of hand and arm movement after stroke, cerebral palsy, brachial plexus injury, multiple sclerosis (MS) and traumatic brain injury (TBI). CI therapy consists of a family of treatments that teach the brain to “rewire” itself following a neurological injury. CI therapy is based on research by Prof. Edward Taub and his collaborators at the University of Alabama at Birmingham, USA that showed that patients can learn to improve movement of the weaker part of their bodies.CIMT is a 2-3 week treatment program that includes restraint of the non-affected hand for most of the waking hours and intensive practice of the affected one for specific hours per day. Practice is focused on everyday activities that are important for the patient and takes place in the clinic and at home. The daily home-based program is tailor made to match each person’s

HOW CIMT WORKS

CIMT includes restraint of the non-affected hand and intensive, everyday practice to the affected arm and hand.

CIMT’s functional effects have been observed as early as on the 3rd-4th day of the program. Improvements have been recorded to last for years after termination of therapy; the reason for this is that CIMT eventually increases the spontaneous use of the affected hand. That is directly linked to research studies showing that CIMT is the only rehabilitation technique to markedly change the organization of activity in the brain and remodel brain structures.

EFFECTIVENESS

CIMT is the only rehabilitative technique that is evidence based to substantially improve arm and hand movement in both adults and children in a 2-3 week period. A large, supporting body of research studies is available, some of which are large sampled randomized controlled trials. The most important finding from research studies and clinical observations is that improvements last for months or years after termination of the CIMT program.

CONDITIONS CIMT IS SUITABLE FOR

CIMT is suitable for adults and children that face movement difficulties (mostly) with their one arm and hand. This might have been the result of a central or peripheral neurological damage.

Although CIMT has been primarily designed for hemiplegia (muscle weakness and movement difficulties of the one side of the body), it can also be effective in quadriplegia when the one side of the body is the one that causes the main dysfunction. In general, CIMT is suitable for any case that non-use of the one arm/ hand affects the person’s independency in everyday activities.

To determine whether CIMT might be suitable for you, our therapists will apply a thorough functional evaluation.

The usual conditions that we treat are the following:

Cerebral Palsy

Cerebral palsy (CP) is the result of damage to the premature brain, either during pregnancy, birth or early infant years. CP can lead to muscle weakness, incoordination of movements and affected muscle tone. CP can affect all four limbs (quadriplegia), lower limbs only (diplegia) or one side of the body (hemiplegia). CIMT is suitable for hemiplegic CP and specific quadriplegic cases.

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Cerebrovascular Accident (Stroke)

A stroke usually results in movement difficulties in one side of the body (hemiplegia). Early after the incident, movement of the affected hand is clumsy and inefficient leading to unconscious avoidance of this part of the body and use of the healthy hand throughout most everyday activities. This compensation leads to further functional decrements as the muscles lose more of their strength, being underused.

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Brachial plexus injury-BPI (Obstetrical Palsy)

The brachial plexus is responsible for sensory and movement innervation of the entire upper limb. Lesions of the brachial plexus can lead to severe functional impairment. Obstetrical Palsy is a special type of BPI that occurs during the birthing process and affects all or part of the infant’s arm and hand.

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Multiple Sclerosis (MS)

Multiple Sclerosis is a chronic, auto-immune condition which means that for some unidentified reason the body triggers an inflammatory response affecting the nerves in the brain and/ or spinal cord. This can affect a person’s movements as the brain is unable to effectively transmit the messages to the nerves supplying the muscles. Movements may be slower and uncoordinated leading to functional problems with one or both arms during everyday activities.

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Traumatic Brain Injury (TBI)

Traumatic brain injury may occur in the area of the brain responsible for controlling movements in the arm and hand, leading to hemiplegia. It is known that people who have arm and hand weakness are more likely to compensate during functional activities by using their stronger arm. The reason for this is that movement of the weaker arm and hand may be slower or demanding greater effort, thus causing frustration. This condition progressively results in “forgetting” use of the weaker hand and spontaneously using only the healthy hand to accomplish everyday activities. This compensation leads to further functional decrements as the muscles lose more of their strength, being underused.

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[ARTICLE] Assessment of the Efficacy of ReoGo-J Robotic Training Against Other Rehabilitation Therapies for Upper-Limb Hemiplegia After Stroke: Protocol for a Randomized Controlled Trial – Full Text

Background: Stroke patients experience chronic hemiparesis in their upper extremities leaving negative effects on quality of life. Robotic therapy is one method to recover arm function, but its research is still in its infancy. Research questions of this study is to investigate how to maximize the benefit of robotic therapy using ReoGo-J for arm hemiplegia in chronic stroke patients.

Methods: Design of this study is a multi-center parallel group trial following the prospective, randomized, open-label, blinded endpoint (PROBE) study model. Participants and setting will be 120 chronic stroke patients (over 6 months post-stroke) will be randomly allocated to three different rehabilitation protocols. In this study, the control group will receive 20 min of standard rehabilitation (conventional occupational therapy) and 40 min of self-training (i.e., sanding, placing and stretching). The robotic therapy group will receive 20 min of standard rehabilitation and 40 min of robotic therapy using ReoGo®-J device. The combined therapy group will receive 40 min of robotic therapy and 20 min of constraint-induced movement therapy (protocol to improve upper-limb use in ADL suggests). This study employs the Fugl-Meyer Assessment upper-limb score (primary outcome), other arm function measures and the Stroke Impact Scale score will be measured at baseline, 5 and 10 weeks of the treatment phase. In analysis of this study, we use the mixed effects model for repeated measures to compare changes in outcomes between groups at 5 and 10 Weeks. The registration number of this study is UMIN000022509.

Conclusions: This study is a feasible, multi-site randomized controlled trial to examine our hypothesis that combined training protocol could maximize the benefit of robotic therapy and best effective therapeutic strategy for patients with upper-limb hemiparesis.

Introduction

Severe, persistent paresis occurs in over 40% of stroke patients (1) and is reported to significantly decrease their quality of life (2). Thus, much research has been conducted to develop interventions, with many specifically targeting upper extremity hemiplegia. Among the many examples of neuroscience-based rehabilitation (neuro-rehabilitation) strategies, there is strong evidence supporting robotic therapy, constraint-induced movement therapy (CIMT), and task-oriented training (34).

Robotic therapy is considered an effective intervention for mild to severe hemiplegic arm (56), and is cost-effective for chronic stroke patients in terms of both manpower and medical costs (78). However, its effects may be limited for some patients. Some researchers have found that robotic therapy effectively improves arm function as measured by the Fugl-Meyer Assessment (FMA) (9) and Action research arm test (ARAT) (10), but does not improve the use of the affected arm in activities of daily living (ADL) as measured by the Motor activity log (MAL)-14 (11) and by analysis of data from an accelerometer attached to the affected arm (61214).

On the contrary, CIMT is the most well-established intervention for improving the use of the affected arm in ADL (15). CIMT consists of three components: (1) a repeated task-oriented approach, (2) a behavioral approach to transfer the function gained during training to actual life (also called the “transfer package”), and (3) constraining use of the affected arm. Some researchers consider the transfer package the most important component of CIMT. In fact, research has shown that usage of the affected arm in daily life is significantly different between patients treated with and without the transfer package component (1617). However, many therapists question whether CIMT could benefit their patients because of the shortage of sites possessing the clinical resources to provide the intervention for the long duration required for effectiveness (18).

Therefore, there is an urgent need to establish an effective therapeutic approach, especially for upper-limb hemiplegia during the chronic stage of stroke recovery for which there are few clinical resources (In Japan, the insurance system only allows 260 min per month). Therefore, we will compare the efficacy of several therapy methods. As a control, we will monitor changes in arm function in patients undergoing a short, standard rehabilitation by a therapist and standard self-training (control group). This will be compared to similar self-training including robotic therapy with the ReoGo-J device as an adjuvant therapy (RT group). Finally, the robotic therapy will be compared to combined therapy including robotic therapy and CIMT (CT group). Through these comparisons, we will investigate the effect of robotic therapy, both alone and in combination with CIMT, which we hypothesize will complement each other in chronic stroke rehabilitation. Here, we report the structure and protocol of a multi-center, randomized controlled trial.[…]

 

Continue —> Frontiers | Assessment of the Efficacy of ReoGo-J Robotic Training Against Other Rehabilitation Therapies for Upper-Limb Hemiplegia After Stroke: Protocol for a Randomized Controlled Trial | Neurology

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[Abstract] Assessment of the Efficacy of ReoGo-J Robotic training against other rehabilitation therapies for Upper-Limb Hemiplegia after Stroke: Protocol for a Randomized Controlled Trial

Background: Stroke patients experience chronic hemiparesis in their upper extremities leaving negative effects on quality of life. Robotic therapy is one method to recover arm function, but its research is still in its infancy. Research questions of this study is to investigate how to maximize the benefit of robotic therapy using ReoGo-J for arm hemiplegia in chronic stroke patients.

Method: Design of this study is a multi-center parallel group trial following the prospective, randomized, open-label, blinded endpoint (PROBE) study model. Participants and setting will be 120 chronic stroke patients (over 6 months post-stroke) will be randomly allocated to three different rehabilitation protocols. In this study, the control group will receive 20 minutes of standard rehabilitation (conventional occupational therapy) and 40 minutes of self-training (i.e., sanding, placing and stretching). The robotic therapy group will receive 20 minutes of standard rehabilitation and 40 minutes of robotic therapy using ReoGo®-J device. The combined therapy group will receive 40 minutes of robotic therapy and 20 minutes of constraint-induced movement therapy (protocol to improve upper-limb use in ADL suggests). This study employs the Fugl-Meyer Assessment upper-limb score (primary outcome), other arm function measures and the Stroke Impact Scale score will be measured at baseline, 5 weeks, and 10 weeks of the treatment phase. In analysis of this study, we use the mixed effects model for repeated measures to compare changes in outcomes between groups at Week 5 and 10. The registration number of this study is UMIN000022509.

Conclusion: This study is a feasible, multi-site randomized controlled trial to examine our hypothesis that combined training protocol could maximize the benefit of robotic therapy and best effective therapeutic strategy for patients with upper-limb hemiparesis.

via Frontiers | Assessment of the Efficacy of ReoGo-J Robotic training against other rehabilitation therapies for Upper-Limb Hemiplegia after Stroke: Protocol for a Randomized Controlled Trial | Neurology

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[BLOG POST] Repetition Improves Stroke Recovery Time – Saebo

In all stages of growth and development, repetition is key to successful long-term learning and information retention. Repetition is especially beneficial for stroke survivors who seek to regain motor function, strength, and coordination. Consistent repetition that re-establishes communication between the damaged parts of the brain and the body is crucial in stroke rehabilitation.

The brain is our most complex organ and scientists still don’t fully understand it, but we have extensive evidence of one amazing capability called “neuroplasticity.” Neuroplasticity is the brain’s ability to form new synapses, or connections between neurons, especially in response to a brain injury. The nervous system compensates for damage by reorganizing the neurons that remain intact. To form new connections, the involved neurons must be stimulated through consistent activity. Fully understanding this process—and why it works—motivates and clarifies the essential role of repetition in post-stroke rehabilitation.

Neuroplasticity Is The Ability To Heal

For our bodies to perform even the simplest tasks, networks of nerve cells, or neurons, must act in tandem to stimulate the correct parts of our bodies. However, when a stroke causes damage to an area of the brain, damaged neurons become unable to send out signals to the corresponding regions of the body. Although a stroke survivor may appear to have suffered damage to an area of the body—for example, the right arm and leg might be paralyzed—the issue actually stems from damage in the brain.

Amazingly, the brain compensates for these losses through various regenerative strategies. A common process, neuroplasticity, is something that the brain undergoes whenever we learn a new piece of information. As our environments and daily routines change throughout life, we create new synapses, or neural connections. During a healing process, the brain is even more engaged when building these new networks. Synaptic pathways are restructured to work around damaged neurons and may even relocate to entirely different areas of the brain.

Under the right circumstances, the brain can even create new neurons in a process known as neurogenesis. Any healing process requires a healthy body, to support the regeneration of cells, and neurogenesis is no different—the regenerating areas of the brain must be healthy, with the proper blood and oxygen supply, and must be activated consistently. Stroke survivors can encourage neurogenesis through frequent therapy, as well as at-home practice. Careful, diligent practice also ensures that new synapses and neurons do not lead to additional issues or symptoms.

Research has shown that stroke survivors who use repetition to promote neuroplasticity enjoy significant progress in their recovery. In one study, patients who initially struggled with grasp-and-release exercises demonstrated increased cortical reorganization after adhering to a repetitive rehabilitation regimen.

Visualize Progress And Challenge Yourself

We are only just beginning to discover the magnitude of the brain’s capabilities. Not only can the brain heal itself through proper support and repetitive exercises, but it can also respond positively to diligent and focused visualization of those same exercises. People who visualize a process can strengthen the involved synapses without performing the actual, physical motion. Visualization is a great introduction to rehabilitation for those who cannot physically complete the motions. In the early stages of regaining motor function or range-of-motion in an affected limb, it is important for stroke survivors to apply themselves to visualization with the same commitment as they would a physical exercise.

Ia 1995 study, synapses strengthened in participants who imagined completing a particular piano exercise. Even though they were not performing any physical motions, their brains still registered and retained the musical information. This principle is vital for those in the early stages of stroke recovery. Visualization bridges the gap between the motivational difficulties inherent to the early stages of rehabilitation and the more physically intense practices later on in recovery.

The transition between visualization and physical performance can be challenging. Supportive tools such as the SaeboMAS provide support to the affected limb while relieving stress from the joints and muscles involved in the exercise. By guiding the arm through its first physical motions, SaeboMAS helps the brain transition from visualization to independent task completion. Tools like SaeboMAS also encourage consistency in motion, a crucial factor when attempting such intensely repetitive action.

Once you master a repetitive action, it’s important to continue challenging yourself with an exercise routine. This is against human nature because once a task feels easy, we feel that we have succeeded; however, repetitions while on autopilot are far less beneficial than when the individual is actively focused on performing each repetition. It takes self-discipline to continue increasing the difficulty of an exercise but you can derive motivation from the support of a therapist, friends or family.

CIMT—or Constraint Induced Movement Therapy— allows for personal adjustments to the difficulty of an exercise. It’s common for those healing from motor function difficulties to avoid challenging the affected limb, overcompensating with the healthy limb to the point that the affected limb begins to deteriorate further due to non-use. Once the patient can comfortably rely on the affected limb, CIMT introduces “shaping” or “adaptive task practice”: the deconstruction of complex physical tasks into manageable steps that are added one at a time. This gradual addition of challenges deters the patient from switching to autopilot during long, repetitive sets.

A motivated and clear mindset is crucial, therefore the exercises themselves must follow a natural progression to become more challenging, while not being too frustrating. This balance comes from respecting each motion—no matter how small—as an important building block in the healing process. By remaining present in the repetitions, the brain picks up on more detailed messages from the body about what it needs. Any associated soreness or pain should be discussed with professionals to ensure that exercises are promoting healing and not inadvertently causing further damage.

Practice With Purpose

As mindfulness increases, it will become clearer which exercises are right for each particular day, depending on how the body feels. By honoring your body as your guide, you will improve your motivation and the physical progression of neuroplasticity. However, sensing what is best for the body is a tricky practice. Harder tasks may challenge a wider variety of neural networks, speeding up the healing process even when the exercise itself feels less successful.

Overall, it’s better to challenge the brain by moving beyond repetition that no longer inspires further improvement. Start small by mastering simpler tasks and skills, then immediately move on to slightly harder versions of those actions. Always maintain the same level of consistency, but with added restraint or weight. Without added challenges, the progress made through rehabilitation can be lost. It may help to view this healing process as a long-term, ongoing journey with the goal of fully rebuilding and re-strengthening connections that would otherwise be lost.

Canadian psychologist Dr. Donald Hebb claimed that “neurons that fire together, wire together,” in his 1949 book, “The Organization of Behavior.” Long before today’s societal focus on mindfulness, Dr. Hebb recognized the occurrence of neurological regrowth when an activity or thought process is repeated diligently. This observation is pertinent to unlearning less helpful habits or thought patterns, as well. If someone in rehabilitation develops a bad habit, such as injuring a healthy limb through overuse, the brain can unlearn these habits through careful repetition.

Mindfulness Leads To Motivation

The benefits of mindfulness are open to all kinds of learning. Intentional focus during practice is the only way to ensure the brain is fully present and supported for neuroplasticity and neurogenesis. During visualization, each movement should be imagined with extreme specificity as well; awareness that is too unspecific can lead to apathy and lack of concentration. Visualization can be motivating, pushing the person in rehabilitation past the plateau stage—a dispiriting time in the process in which progress stalls. Overall, the trick is to keep exercises from becoming routine. When each day is different or challenging in a new way, the brain stays engaged in ways more conducive to synaptic rehabilitation.

You Need To Move

The most important mantra for post-stroke recovery is to keep moving. Once an intention or goal has been set, consistent movement is the key to warding off muscular atrophy. As mentioned earlier, even before physical movement is possible, exercises can be completed in the brain through visualization. Begin as soon as possible after the injury to take full advantage of early neurogenesis before entering the plateau phase. Whether visualizing or physically completing an action, repetition  is the most important factor in long-term recovery.

How Much Is Enough?

The question remains, how many repetitions are enough to regain full health during stroke rehabilitation? The number of repetitions required to establish a neural pathway depends on multiple factors:

  • the type of exercise
  • the area of the body
  • the current health of the muscles, nerves, and joints

Consistent, dedicated repetition is the most important priority. Without this, the brain cannot complete the rebuilding of the neurons, networks, and capabilities it lost during the stroke.

Quality of repetitions is just as important as quantity. Practice is helpful only while remaining mindful and fully present. Concentration also bolsters motivation, especially when progress plateaus.

Together, mindfulness and repetition move those in rehabilitation past initial discomfort more quickly by strengthening the affected muscles and neurons. We now know that visualization and drive have a psychosomatic effect, speeding up rehabilitation while the brain is most susceptible to healing. Visit the Saebo blog for more information about healing after a stroke.


All content provided on this blog is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. If you think you may have a medical emergency, call your doctor or 911 immediately. Reliance on any information provided by the Saebo website is solely at your own risk.

via Repetition Improves Stroke Recovery Time | Saebo

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[Abstract] Neurophysiological effects of constraint-induced movement therapy and motor function: A systematic review

There is a claim that improvements in motor function in people with stroke following constraint-induced movement therapy (CIMT) is due to compensation but not actually neurorestoration. However, few studies have demonstrated improvements in neurophysiological outcomes such as increased motor map size and activation of primary cortex, or their positive correlations with motor function, following CIMT. The aim of this study was to carry out a systematic review of CIMT trials using neurophysiological outcomes, and a meta-analysis of the relationship between the neurophysiological outcomes and motor function.

The PubMed, PEDro and CENTRAL databases, as well as the reference lists of the included studies, were searched. The included studies were randomised controlled trials comparing the effect of CIMT on neurophysiological outcomes compared with other rehabilitation techniques, conventional therapy, or another variant of CIMT. Methodological quality was assessed using the PEDro scale. The data extracted from the studies were sample size, eligibility criteria, dose of intervention and control, outcome measurements, and time since stroke.

A total of 10 articles (n=219) fulfilled the study inclusion criteria, all of which were used for narrative synthesis, and four studies were used in the meta-analysis. The methodological quality of the studies ranged from low to high. Strong, positive, and significant correlations were found between the neurophysiological and motor function outcomes in fixed effects (z=3.268, p=0.001; r=0.52, 95% confidence interval (CI) 0.227–0.994) and random-effects (z=2.106, p=0.035; r=0.54, 95% CI 0.0424–0.827) models.

Randomised controlled trials evaluating the effects of CIMT on neurophysiological outcomes are few in number. Additionally, these studies used diverse outcomes, which makes it difficult to draw any meaningful conclusion. However, there is a strong positive correlation between neurophysiological and motor function outcomes in these studies.

 

via Neurophysiological effects of constraint-induced movement therapy and motor function: A systematic review | International Journal of Therapy and Rehabilitation | Vol 25, No 4

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[Abstract] Efficacy of upper limb constraint-induced movement therapy in patients with stroke and impact on community activities: Outcomes of a pilot phase study

Abstract

Introduction

Constraint-Induced Movement Therapy (CIMT) is one of the techniques used to promote sensory-motor recovery of the upper limb in patients with stroke. The aim of this study was to design a pilot phase randomized controlled clinical trial to assess the efficacy of CIMT in the motor performance, and the incorporation of the affected upper limb in community tasks in stroke patients with less than 3 months of evolution.

Materials and methods

The sample was randomly assigned to either CIMT (n = 7) or a control group (n = 6). The outcome measures were assessed pre- and post-intervention by using the Fugl-Meyer Motor Assessment (FMA); dynamometry; Functional Independence Measure (FIM); Arm Motor Ability Test (AMAT); Motor Activity Log (MAL); and Community Activities Scale (CAS).

Results

Both groups were similar on demographics, clinical and baseline outcome scales. Significant effects were noted post-intervention in the CIMT group on AMAT (P<.05), MAL (p<.05), and CAS (P=.05). There were no differences on FMA (P=.880), dynamometry (P=.356), and FIM (P=.508) scores. CAS scale was correlated with tests for assessing the functionality of the upper limb. The relationship was high with the FMA scale (rho=.673) and time (rho = –.627), functional ability (rho=.784) and quality of movement (rho = 735) subscales of AMAT.

Conclusions

CIMT is effective to improve the integration and quality of movement of the affected upper limb in daily life activities and community tasks in individuals with stroke.

 

via Eficacia de la terapia de movimiento inducido por restricción para miembros superiores en pacientes con accidente cerebrovascular y su impacto en actividades de la comunidad: resultados de la fase piloto – ScienceDirect

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[ARTICLE] The Functional Recovery and the Associated Cortical Reorganization Following Constraint-Induced Movement Therapies (CIMTs) in Stroke. – Full Text PDF

Abstract

Constraint-Induced Movement Therapies (CIMTs) including the original Constraint- Induced Movement Therapy (CIMT) and the Modified Constraint-Induced Movement Therapy (mCIMT) gained considerable popularity as a treatment approach for upper extremity rehabilitation among patients with mild-to-moderate stroke.

However, a major barrier in rehabilitation generally and in CIMTs specifically; is the limited objectivity of some commonly used outcome measures and lack sensitivity to define “True” recovery vs. compensation. Thereby, they may not sufficiently detect of long term consequences and the associated neurological recovery. An essential approach to overcome such barrier is to better understand functional motor recovery, associated neural changes and how they may relate to recovery of the pre-morbid movement pattern.

Such Understanding for these relationships would add more in-depth insights on the
functional relevance of plastic brain changes in stroke following CIMTs to optimize the field of neuro-rehabilitation. This review synthesizes findings from studies to on the use of the CIMTs including CIMT and mCIMT as efficient practice in the management of upper limb dysfunction following a stroke. The analysis will include (1) the functional recovery and (2) the cortical reorganization following the use of mCIMT and CIMT on patients in the chronic stage following stroke.

Introduction

Stroke is considered the fifth leading cause of death in the United
States [1]. To date, stroke affects at least 6.4 million persons in the United
States [2]. Projections show that by 2030, an additional 3.4 million
people above 18 years will have had a stroke which is approximately a
20.5% increase in prevalence from 2012 statistics [1]. Stroke is a leading
cause of serious long-term disability in the United States [1].

Arm paresis is one of the most common impairments after stroke
[3,4]. After six months, about two-thirds of patients continue to suffer
from arm sensorimotor impairment that impacts the individual’s
activities of daily living [5]. Motor deficits consist of weakness of
specific muscles [6], abnormal muscle tone [7-9], abnormal postural
adjustments [10], abnormal movement synergies [11], lack of mobility
between structures at the shoulder girdle [10] and incorrect timing
of components within a movement pattern [12]. As a result of such
impairment, patients may progressively avoid using the affected arm in
favor of the unaffected arm for successful ADL, resulting in a learned
non-use phenomenon [13].[…]

Full Text PDF

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[Abstract] Occupational therapy for the upper limb after stroke: implementing evidence-based constraint induced movement therapy into practice. – Doctoral thesis

Abstract

Background
Constraint induced movement therapy (CIMT), an intervention to increase upper limb (UL) function post-stroke, is not used routinely by therapists in the United Kingdom; reasons for this are unknown. Using the Promoting Action on Research Implementation in Health Services (PARIHS) framework to analyse CIMT research and context, a series of related studies explored implementation of CIMT into practice.

Methods and Findings
Systematic review: nineteen CIMT randomised controlled trials found evidence of effectiveness in sub-acute stroke, but could not determine the most effective evidence-based protocols. Further review of qualitative data found paucity of evidence relating to acceptability and feasibility of CIMT.
Focus group: perceptions of the feasibility, including facilitators and barriers, of implementing CIMT into practice were explored in a group of eight therapists. Thematic analysis identified five themes: personal characteristics; setting and support; ethical considerations; education and training; and practicalities, which need to be addressed prior to implementation of CIMT.

Mixed-methods, pilot study (three single cases): pre- and post-CIMT (participant preferred protocol) interviews explored perceptions and experiences of CIMT, with pre- and post-CIMT measurement of participation and UL function. Findings indicated: (i) provision of evidence-based CIMT protocols was feasible, although barriers persisted; (ii) piloted data collection and analysis methods facilitated exploration of stroke survivors’ perceptions and experiences, and recorded participation and UL function.

Conclusions
Findings traversed PARIHS elements (evidence, context, facilitation), and should be considered prior to further CIMT implementation. Future studies of CIMT should explore: effects of CIMT protocol variations; characteristics of stroke survivors most likely to benefit from CIMT; interactions between CIMT and participation.

Source: Keele Research Repository – Keele University

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[Workshop] Evidence-Based Upper Limb Retraining after Stroke 2017 – Pre-Reading and Workshop Tasks – PDF

CHAPTER 40: Optimizing motor performance and sensation after brain impairment

ABSTRACT

This chapter provides a framework for optimizing motor performance and sensation in adults with brain impairment. Conditions such as stroke and traumatic brain injury are the main focus, however, the chapter content can apply to adults with other neurological conditions. The tasks of eating and drinking are used as examples throughout the chapter. Skills and knowledge required by graduates are identified, including knowledge of motor behaviour, the essential components of reaching to grasp and reaching in sitting, and how to identify compensatory strategies, develop and test movement hypotheses. Factors that enhance skill acquisition are discussed, including task specificity, practice intensity and timely feedback, with implications for therapists’ teaching skills. Finally, a summary is provided of evidence-based interventions to improve motor performance and sensation, including high intensity, task-specific training, mirror therapy, mental practice, electrical stimulation and constraint therapy.

Key Points:

  1. Essential knowledge in neurological rehabilitation includes an understanding of normal motor behaviour, muscle biology and skill acquisition.
  2. Abnormal motor performance can be observed during a task such as reaching for a cup, and compared with expected performance. Hypotheses about the cause(s) of observed movement differences can then be made and tested.

  3. Paralysis, weakness and loss of co-ordination affect upper limb motor performance. To improve performance after brain impairment, therapists should primarily focus on improving strength and co-ordination.

  4. Many people with brain impairment have difficulty understanding instructions, goals and feedback, and consequently may not practice well. To teach people to practice well and learn skills, therapists need to be good coaches.

  5. Motor performance and sensation can be improved using low-cost evidence-based strategies such as high intensity, repetitive, task-specific training, mirror therapy, mental practice, electrical stimulation and constraint-induced movement therapy.

1. Introduction

Upper motor neuron lesions typically cause impairments such as paralysis, muscle weakness and loss of sensation. These impairments can limit participation in everyday tasks such as eating a meal. Motor control is a term commonly used in rehabilitation (Shumway-Cook, 2012; van Vliet et al 2013) and refers to control of movements such as reaching to grasp a cup and standing up. Occupational therapists and physiotherapists retrain motor and sensory impairments that interfere with tasks such as grasping a cup and sitting safely on the toilet.

The aim of this chapter is to provide a framework that helps therapists to systematically observe, analyse and measure motor and sensory impairments. Targeted evidence-based interventions will be described that can drive neuroplasticity. Therapists need to proactively seek muscle activity and sensation. It is not enough to teach a person how to compensate using one-handed techniques, or to wait for recovery to possibly occur.[…]

Full Text PDF

 

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[Abstract] Computer-aided prediction of extent of motor recovery following constraint-induced movement therapy in chronic stroke

Abstract

Constraint-induced movement therapy (CI therapy) is a well-researched intervention for treatment of upper limb function. Overall, CI therapy yields clinically meaningful improvements in speed of task completion and greatly increases use of the more affected upper extremity for daily activities. However, individual improvements vary widely. It has been suggested that intrinsic feedback from somatosensation may influence motor recovery from CI therapy. To test this hypothesis, an enhanced probabilistic neural network (EPNN) prognostic computational model was developed to identify which baseline characteristics predict extent of motor recovery, as measured by the Wolf Motor Function Test (WMFT). Individual characteristics examined were: proprioceptive function via the brief kinesthesia test, tactile sensation via the Semmes-Weinstein touch monofilaments, motor performance captured via the 15 timed items of the Wolf Motor Function Test, stroke affected side. A highly accurate predictive classification was achieved (100% accuracy of EPNN based on available data), but facets of motor functioning alone were sufficient to predict outcome. Somatosensation, as quantified here, did not play a large role in determining the effectiveness of CI therapy.

Source: Computer-aided prediction of extent of motor recovery following constraint-induced movement therapy in chronic stroke – ScienceDirect

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