ABSTRACT
A new therapeutic approach to rehabilitation of movement after stroke, termed Constraint-Induced (CI) Movement Therapy, has been derived from basic research with monkeys given somatosensory deafferentation. CI consists of a family of therapies; their common element is that they induce stroke patients to greatly increase the use of a more affected upper extremity for many hours a day over a 10-14 consecutive-day period. These therapies have significantly improved quality of movement and substantially increased amount of use of a more affected extremity in the activities of daily living in the life situation. The purpose of this paper is to describe the protocol used by the investigative team that developed the family of CI therapies and examined them as an effective rehabilitation approach.
ABSTRACT
A new approach to the rehabilitation of movement, based primarily on the principles of operant conditioning, was derived from research with deafferented monkeys. The analysis suggests that a certain proportion of excess motor disability after certain types of injury involves a learned suppression of movement and may be termed learned nonuse. Learned nonuse can be overcome by changing the contingencies of reinforcement so that they strongly favor use of an affected upper extremity in the chronic postinjury situation. The techniques employed here involved 2 weeks of restricting movement of the opposite (unaffected) extremity and training of the affected limb. Initial work with humans has been with chronic stroke patients for whom the approach has yielded large improvements in motor ability and functional independence. We report here preliminary data suggesting that shaping with verbal feedback further enhances the motor recovery.
