Affiliations: Birmingham VA Medical Center, Birmingham, AL,
USA | Department of Physical Medicine and Rehabilitation,
University of Alabama at Birmingham, Birmingham, AL, USA | Department of Psychology, University of Alabama at
Birmingham, Birmingham, AL, USA
Note: [] Corresponding author: Victor W. Mark, M.D., Department of
Physical Medicine and Rehabilitation, University of Alabama at Birmingham, 619
19th Street South, SRC 190, Birmingham AL 35249-7330, USA. E-mail:
vwmark@uab.edu
Abstract: Constraint-Induced Movement Therapy (CI therapy) refers to a family
of treatments for motor disability that combines constraint of movement, massed
practice, and shaping of behavior to improve the amount of use of the targeted
limb. CI therapy has controlled evidence for efficacy that supports its benefit
for patients with chronic disability following central nervous system injury,
regardless of their age or the interval since illness onset. Furthermore, the
benefits transfer to real-world measures of limb use. Significant functional
improvement may occur even after the patient has been treated with conventional
physical therapy. In this paper we review the evidence for the efficacy of CI
therapy, particularly for chronic stroke hemiparesis, but also for diverse
other chronic disabling illnesses, including non-motor disorders such as
phantom limb pain and aphasia. The adaptation of the therapy to the stroke
clinic is described, along with a review of the neurophysiologic mechanisms
that are postulated to underlie the treatment benefit (overcoming learned
nonuse, plastic brain reorganization). Critical to the success of CI therapy is
its modification according to disease factors, economic considerations,
limitations of the practice setting, and the cognitive and physical status of
the patient. We conclude by recommending future areas for research on CI
therapy.
