Use Of Constraint-induced Movement Therapy Research Articles

Knowledge and perception of occupational therapists and physiotherapists on the use of constraint-induced movement therapy for stroke rehabilitation in South Africa

BACKGROUND: Rehabilitation therapists are expected to manage upper extremities difficulties following stroke by using effective treatment approaches. Constraint-induced movement therapy (CIMT) facilitates upper extremity functional recovery in patients after stroke; however, in South Africa, its application is not well documented. AIM: To assess and compare the knowledge and perception of occupational therapists and physiotherapists on the use of CIMT for stroke rehabilitation in South Africa. METHODS: A descriptive cross-sectional design using a self-administered online questionnaire was distributed via the two national professional societies. Data were analysed descriptively and the Mann-Whitney U and Kruskal Wallis tests were used to make inferences RESULTS: Of 108 respondents, 49.1% (n=53) were occupational therapists, and 50.9% (n=55) physiotherapists. A higher level of education (p=0.037) and working specifically with stroke patients (p=0.050) are significantly associated with better CIMT knowledge and perception. The profession of the participants was not significantly associated with their knowledge and perception of CIMT. CONCLUSION: This study demonstrates gaps in the knowledge of CIMT as a treatment technique for upper extremity impairment following stroke. Although most respondents knew about CIMT, improved guidance and knowledge of CIMT are required to remediate knowledge gaps. This may assist in improving the feasibility of CIMT and thus promote its clinical application, given the prevalence of UE impairment in stroke patients managed by therapists.

Neurobiology of Recovery of Motor Function after Stroke: The Central Nervous System Biomarker Effects of Constraint-Induced Movement Therapy.

Recovery of motor function after stroke involves many biomarkers. This review attempts to identify the biomarker effects responsible for recovery of motor function following the use of Constraint-Induced Movement Therapy (CIMT) and discuss their implications for research and practice. From the studies reviewed, the biomarker effects identified include improved perfusion of motor areas and brain glucose metabolism; increased expression of proteins, namely, Brain-Derived Neurotrophic Factor (BDNF), Vascular Endothelial Growth Factor (VEGF), and Growth-Associated Protein 43 (GAP-43); and decreased level of Gamma-Aminobutyric Acid (GABA). Others include increased cortical activation, increased motor map size, and decreased interhemispheric inhibition of the ipsilesional hemisphere by the contralesional hemisphere. Interestingly, the biomarker effects correlated well with improved motor function. However, some of the biomarker effects have not yet been investigated in humans, and they require that CIMT starts early on poststroke. In addition, one study seems to suggest the combined use of CIMT with other rehabilitation techniques such as Transcortical Direct Stimulation (tDCs) in patients with chronic stroke to achieve the biomarker effects. Unfortunately, there are few studies in humans that implemented CIMT during early poststroke. Thus, it is important that more studies in humans are carried out to determine the biomarker effects of CIMT especially early on poststroke, when there is a greater opportunity for recovery. Furthermore, it should be noted that these effects are mainly in ischaemic stroke.

Feasibility of application of constraint-induced movement therapy in a child with hemiplegic cerebral palsy: A single-case study

Children suffering from hemiplegic cerebral palsy (CP) develop developmental disregard (DD). In addition, they fail to comprehend the consequences of nonuse. The utility of affected upper limb is jeopardized. Current evidence supports the use of constraint-induced movement therapy (CIMT) for upper limb function in individuals with hemiplegia. This single-case study attempts to identify feasibility of application of pediatric CIMT on a child with hemiplegic CP. The aim of this study is to identify the benefits and feasibility of application of CIMT for improving quality of the upper limb movement in a child with hemiplegic CP. A 2½-year-old girl with hemiplegic CP visited the outpatient department (OPD) with the problem of lack of use of the right upper limb for activities and play along with the poorer quality of the upper limb movement. Disregard index was calculated to identify the presence of DD. CIMT was chosen as the child had above minimal ability to open fingers and extend the wrist. A 2-week intervention was designed based on the goal-oriented, ability-specific, child-specific practice of functional tasks. A rigid tape was used to provide constraint. The child was motivated to play with the affected hand for 2 h in the OPD and 2 h at home. Tasks of incremental difficulty were utilized as shaping method. The improvement in the quality of movement was measured using quality of upper extremity skilled test (QUEST) and Assisting Hand Assessment (AHA). The score on QUEST improved from 66.35 to 72.1, AHA improved from 66 to 73, and the disregard index score improved from 42.75 to 26.3 in 2 weeks. The treatment was adjusted to accommodate the behavior of the child.

Constraint-induced movement therapy in hemiplegic cerebral palsy: A national survey of its use by UK physiotherapists

Background/aims: There is an emerging evidence base into the use of constraint-induced movement therapy in hemiplegic cerebral palsy. However, there is little evidence of its use in the UK. This study conducted a national survey of physiotherapists to explore their use of constraint-induced movement therapy in hemiplegic cerebral palsy and to identify barriers and facilitators to its use. Methods: An online survey was distributed to members of the Association of Paediatric Chartered Physiotherapists within the UK. At this time, there were approximately 2300 members on the professional database. Participants were asked about their experience and views regarding constraint-induced movement therapy use/training, including their beliefs regarding delivery of the therapy in the UK health system. Findings: Responses were from 121 therapists from 12 regions of the UK, working across the National Health Service, private sector and education, based in inpatient, outpatient, community and school settings. Fifty-three percent had never used constraint-induced movement therapy, although 73.6% felt it was an appropriate treatment. Most therapists felt they did not have enough training to use constraint-induced movement therapy. Barriers included ethical issues, resources and training. Facilitators to its use included treatment modification, support of others and outcome appraisal. The ethical and legal ramifications of restraint were a common concern, which prevented therapists from using constraint-induced movement therapy. Family compliance influenced therapists' decision to use constraint-induced movement therapy. Conclusions: There is evidence to suggest physiotherapists in the UK are using constraint-induced movement therapy to some extent in this patient group and that there is established clinical interest. Further research is needed to clarify ethical and legal ramifications of restraint.

Examining the Use of Constraint-Induced Movement Therapy in Canadian Neurological Occupational and Physical Therapy

To investigate the use of constraint-induced movement therapy (CIMT) in Canadian neurological occupational and physical therapy. An online survey was completed by occupational and physical therapists practising in Canadian adult neurological rehabilitation. We measured participants' practices, perceptions, and opinions in relation to their use of CIMT in clinical practice. A total of 338 surveys were returned for a 13% response rate; 92% of respondents knew of CIMT, and 43% reported using it. The majority (88%) of respondents using CIMT employed a non-traditional protocol. Self-rating of level of CIMT knowledge was found to be a significant predictor of CIMT use (p≤0.001). Commonly identified barriers to use included "patients having cognitive challenges that prohibit use of this treatment" and "lack of knowledge regarding treatment." Although the majority of respondents knew about CIMT, less than half reported using it. Barriers to CIMT use include lack of knowledge about the treatment and institutional resources to support its use. Identifying and addressing barriers to CIMT use-for example, by using continuing professional education to remediate knowledge gaps or developing new protocols that require fewer institutional resources-can help improve the feasibility of CIMT, and thus promote its clinical application.

Clinician's Commentary on Fleet et al.

Clinician's Commentary on Fleet et al.

Parallels between use of constraint‐induced movement therapy to treat neurological motor disorders and amblyopia training

There are striking similarities between the visual defect of amblyopia and the motor deficit of the extremities produced by such types of damage to the central nervous system (CNS) as stroke and traumatic brain injury, both after and before maturity. Part of the motor deficit of the extremities following CNS injury can be attributed to a learning phenomenon termed "learned nonuse" or if present from birth, "developmental disregard." The same mechanism is hypothesized to be involved in the development of amblyopia. Treatments that are efficacious in the remediation of these defects, Constraint-Induced Movement therapy and amblyopia training, also share a number of strong similarities. In addition, plastic brain changes are produced by CI therapy and are hypothesized to occur during amblyopia training.

Occupational therapists and the use of constraint‐induced movement therapy in neurological practice

There is adaquate evidence for supporting the use of constraint-induced movement therapy (CIMT) in post-stroke rehabilitation. However, the actual usage of CIMT in routine occupational therapy practice appears limited. Further research is required to study why this might be so.

What is the long-term benefit of constraint-induced movement therapy? A four-year follow-up

Objective: To evaluate the long-term benefits of constraint-induced movement therapy in chronic stroke. Design: A four-year follow-up after constraint-induced group therapy assessing arm and hand function and self-reported daily hand use. Subjects: Fourteen post-stroke individuals (six women and eight men; mean age 59.6 ± 12.7 years, range 23—75 years) with mild to moderate impairments of hand function. Outcome measures: The Sollerman hand function test and the Motor Activity Log test. Results: Four years after constraint-induced group therapy the participants had maintained their hand function, as measured by the Sollerman hand function test. The self-reported use and quality of movements of the more affected hand, as measured by the Motor Activity Log test, had decreased compared to post-treatment and three months follow-up (P<0.01), but was still significantly higher than pre-treatment (P<0.05). Conclusion: There seems to be a long-term benefit of constraint-induced group therapy. Hand function was maintained over time and daily hand use had increased compared to pre-treatment. To provide guidelines about the clinical use of constraint-induced movement therapy further, larger and controlled studies are needed.

Constraint-Induced Movement Therapy for Individuals After Cerebral Hemispherectomy: A Case Series

This case report describes the feasibility and efficacy of the use of constraint-induced movement therapy (CIMT) in 4 individuals (aged 12-22 years) who underwent cerebral hemispherectomy (age at time of surgery=4-10 years). The aims of this case series were: (1) to evaluate the feasibility of this therapeutic approach involving a shortened version of CIMT, (2) to examine improvements that occurred within the upper extremity of the hemiparetic side, (3) to investigate the feasibility of conducting brain imaging in individuals with depressed mental ages, and (4) to examine changes in the sensorimotor cortex following intervention. The patients received a shortened version of CIMT for 3 hours each day for a period of 10 days. In addition, a standard resting splint was used for the unimpaired hand for an 11-day period. Each patient was encouraged to wear the splint for 90% of his or her waking hours. The following outcome measures were used: the Actual Amount of Use Test (AAUT), the Box and Block Test (BBT), and the upper-extremity grasping and motor portions of the Fugl-Meyer Assessment of Motor Recovery (FM). Immediately after therapy, improvements were found in AAUT and BBT scores, but no improvements were found in FM scores. Three patients underwent brain imaging before and after therapy and showed qualitative changes consistent with reorganization of sensorimotor cortical representations of both paretic and nonparetic hands in one isolated hemisphere. The findings suggest that CIMT may be a feasible method of rehabilitation in individuals with chronic hemiparesis, possibly leading to neuroplastic therapy-related changes in the brain.

Pediatric Constraint-Induced Movement Therapy in a Young Child With Minimal Active Arm Movement

This study describes a single-subject design (ABA with follow-up evaluation) that demonstrated the possible effective use of constraint-induced movement therapy (CIMT) in producing gains in movement and function for a 24-month-old child with chronic hemiparesis. The noninvolved upper extremity was placed in a removable splint for 21 consecutive days. The child was involved in intensive occupational therapy in the home environment. Daily measurements were completed on the use and quality of motion of the involved upper extremity for eight specific fine and gross motor activities. Change in performance and quality of movement were measured and significant at the p < .05 level with the calculation of the C statistic for the motor activities with gains maintained after completion of the treatment and postsplinting phases. The results of the study contribute to the body of evidence finding CIMT to be effective for increasing movement and function in children with hemiparesis.