NeuroRehabilitation - Volume 21, issue 2

Authors: Taub, Edward | Uswatte, Gitendra

Article Type: Introduction

Abstract: Constraint-Induced Movement therapy or CI therapy is a behavioral approach to neurorehabilitation based on a program of neuroscience experiments conducted with deafferented monkeys. Over the last 20 years, a large body of evidence has accumulated to support the efficacy of CI therapy for rehabilitating hemiparetic arm use in individuals with chronic stroke. Given the persuasive evidence for its efficacy to date, other research questions have risen to the forefront. How cost-effective is CI therapy? What are optimal training and other treatment parameters? What patient characteristics moderate the effects of CI therapy? The papers gathered in this special issue address many …of these topics. Show more

DOI: 10.3233/NRE-2006-21201

Citation: NeuroRehabilitation, vol. 21, no. 2, pp. 93-95, 2006

Authors: Sterr, Annette | Saunders, Amy

Article Type: Research Article

Abstract: Traditional rehabilitation for hemiplegia is not necessarily based on a supported theoretical foundation and some evidence questiones the efficacy of current practice. The uncertainty relating to underlying theories is a serious issue, henceforth there has been a move to base treatment strategies on scientific foundations which incorporate knowledge of human learning mechanisms and accompanying neurobiological processes. In this paper we argue that constraint induced movement therapy is a potentially very effective intervention that benefits from a strong theoretical grounding. It is demonstrated that the treatment mechanisms are supported by established behavioural learning theory and evidence of brain plasticity. …As empirical support for the therapy is gradually mounting, the integration into mainstream practice lends itself as a natural course. In this paper, a series of issues surrounding the distribution of CIT such as constraint use, dose response relationships and accessibility to a wider group of patients are discussed. Further research in these areas is considered important for CIT integration into mainstream practice. Show more

DOI: 10.3233/NRE-2006-21202

Citation: NeuroRehabilitation, vol. 21, no. 2, pp. 97-105, 2006

Authors: Nadeau, Stephen E. | Wu, Samuel S.

Article Type: Research Article

Abstract: A physiological adjuvant to neuroplasticity cannot put new knowledge into the brain – it can only augment behavioral rehabilitation, which does replace knowledge in the brain lost due to injury. Clinical trials of adjuvant agents should therefore incorporate behavioral engines: behavioral therapies that have a potent effect and minimize error variance due to variability in subject attributes and the administration of the therapy. We consider in some detail the attributes of behavioral engines with a particular focus on constraint induced movement therapy. Human trials of physiological adjuvants to neuroplasticity are predicated on discoveries from animal research. Because human trials are …expensive and carry risk of injury, it behooves us to lay a comprehensive foundation for these trials with animal studies (also incorporating behavioral engines) and to carefully mesh animal and clinical work. We review in detail our own and others' work involving human subjects with brain lesions and animal models of brain injury using donepezil, a central acetyl cholinesterase inhibitor, d-cycloserine, a partial agonist at the NMDA receptor glycine site, d-amphetamine, and methylphenidate in an effort to elucidate the strengths and weakness of animal and human neurorehabilitation science with respect to this mesh between animal and human subject research. We consider modifications in current approaches that might more efficiently advance neurorehabilitation science. Show more

Keywords: Constraint induced movement therapy, hemiparesis, rehabilitation, donepezil, cycloserine, amphetamine, stroke

DOI: 10.3233/NRE-2006-21203

Citation: NeuroRehabilitation, vol. 21, no. 2, pp. 107-130, 2006

Authors: Morris, David M. | Shaw, Sharon E. | Mark, Victor W. | Uswatte, Gitendra | Barman, Joydip | Taub, Edward

Article Type: Research Article

Abstract: The great prevalence of traumatic brain injury (TBI) and its high economic costs make reducing TBI-related disability a national health care priority. In our research laboratory, CI therapy has been found to significantly improve upper extremity function for persons with chronic TBI. The results have suggested that persons with TBI are less likely to adhere to critical components of the CI therapy protocol than participants with stroke in other studies. Treatment outcomes have also been more variable. Our findings suggest that some cognitive skills appear related to treatment outcome. In addition, cognitive and behavioral deficits, commonly seen with participants with …TBI, challenge the delivery of the standard CI therapy protocol with some persons. We discuss the implications of these neuropsychological factors for CI therapy used for chronic TBI and propose further research to more thoroughly investigate these issues. Show more

Keywords: CI therapy, traumatic brain injury, rehabilitation, neuropsychological assessment, upper extremity

DOI: 10.3233/NRE-2006-21204

Citation: NeuroRehabilitation, vol. 21, no. 2, pp. 131-137, 2006

Authors: Mark, Victor W. | Woods, Adam J. | Mennemeier, Mark | Abbas, Sheerin | Taub, Edward

Article Type: Research Article

Abstract: Objective: To evaluate in a preliminary fashion whether several standard cognitive assessments predict treatment outcomes on real-world functional activities following Constraint-Induced Movement therapy (CI therapy) for either the upper extremity (UE) or the lower extremity (LE) for chronic stroke hemiparesis in the outpatient therapy clinic. Methods: 15 UE and 14 LE patients in the clinic underwent a short battery of cognitive assessments that evaluated sustained attention, episodic memory, executive control abilities, and general cognitive function. Spearman correlation analysis was used to evaluate whether each cognitive test predicted treatment outcome on the limb-specific Motor Activity Log (MAL). …Results: Two assessments (delayed verbal memory and Trail Making Test form B) significantly correlated with LE MAL change that followed therapy. Conclusions: We tentatively conclude from this exploratory and preliminary study that cognitive performance may predict treatment changes in response to CI therapy for the LE. Moderate to large correlations that we observed between other cognitive assessments and CI therapy outcomes recommend replicating this study with a larger and more cognitively diverse sample of stroke patients to learn if these findings are generalizable. Show more

Keywords: Cerebrovascular accident, rehabilitation, neuropsychological assessment

DOI: 10.3233/NRE-2006-21205

Citation: NeuroRehabilitation, vol. 21, no. 2, pp. 139-146, 2006

Authors: Uswatte, Gitendra | Taub, Edward | Morris, David | Barman, Joydip | Crago, Jean

Article Type: Research Article

Abstract: Two important components of Constraint-Induced Movement therapy are thought to be intense training of the more-impaired arm and physical restraint of the less-impaired arm. This preliminary study examined the effects of type of training (task-practice, shaping) and restraint (sling, half-glove, no restraint) on treatment outcomes. Seventeen individuals at least 1-year post-stroke with mild/moderate upper extremity motor deficit were consecutively assigned to Sling and Task-practice, Sling and Shaping, Half-glove and Shaping, and Shaping Only groups. Task-practice involved repetitive more-impaired arm training on functional tasks for 6 hr/day for 10 consecutive weekdays. Shaping differed from task-practice in that task demands were progressively …increased and immediate performance feedback was provided frequently and systematically. “Sling” groups placed the less-impaired arm in a resting hand-splint/sling assembly for most waking hours over the 2-week intervention, while the “Half-glove” group wore a modified gardening glove as a reminder not to use the more affected arm in the life situation. There were no between-group differences in outcome at post-treatment, although two-years afterwards Sling & Task-practice and Half-glove & Shaping participants showed larger and smaller retention of gains, respectively, than those in the Sling & Shaping group. Thus, long-term outcomes may have been affected by type of more-impaired arm motor training and less-impaired arm restraint. These variables, however, were confounded with between-group differences in training intensity, limiting confidence in this conclusion. Show more

Keywords: Stroke, arm, rehabilitation, clinical trials, treatment outcome

DOI: 10.3233/NRE-2006-21206

Citation: NeuroRehabilitation, vol. 21, no. 2, pp. 147-156, 2006

Authors: Mennemeyer, Stephen T. | Taub, Edward | Uswatte, Gitendra | Pearson, Sonya

Article Type: Research Article

Abstract: Randomized controlled clinical studies show that Constraint-Induced Movement therapy (CI therapy) improves impaired arm function in patients with stroke. Little is known about how this therapy affects employment of patients or their caregivers. Individuals more than 1-year post-stroke (N = 121) were retrospectively surveyed about their activities and employment prior to stroke, after stroke but before CI therapy and after CI therapy. They were also asked if someone had stopped working to be a caregiver and if that person had resumed employment. Before stroke, 48% of patients had been employed; this fell to 22% after …stroke and did not significantly rise after CI therapy with most of the newly unemployed moving into a permanent retirement status before starting CI therapy. Among the CI therapy patients, one-quarter (29/121) reported that someone had limited their employment to take care of them following their stroke. After CI therapy, more than 60% (18/29) of caregivers returned to employment. Our preliminary finding regarding return to work by caregivers of stroke patients post-CI therapy warrants further study using prospective methods and randomized, controlled designs. Show more

Keywords: Stroke, rehabilitation, cost benefit analysis, employment

DOI: 10.3233/NRE-2006-21207

Citation: NeuroRehabilitation, vol. 21, no. 2, pp. 157-165, 2006

Authors: Bowman, Mary H. | Taub, Edward | Uswatte, Gitendra | Delgado, Adriana | Bryson, Camille | Morris, David M. | McKay, Staci | Mark, Victor W.

Article Type: Research Article

Abstract: Constraint-Induced Movement therapy (CI therapy) is a recognized rehabilitation approach for persons having stroke with mild to moderately severe motor upper extremity deficits. To date, no rehabilitation treatment protocol has been proven effective that addresses both motor performance and spontaneous upper extremity use in the life situation for chronic stroke participants having severe upper extremity impairment with no active finger extension or thumb abduction. This case report describes treatment of a chronic stroke participant with a plegic hand using a CI therapy protocol that combines CI therapy with selected occupational and physical therapy techniques. Treatment consisted of six sessions of …adaptive equipment and upper extremity orthotics training followed by a three-week, six-hour daily intervention of CI therapy plus neurodevelopmental treatment. Outcome measures included the Motor Activity Log for very low functioning patients (Grade 5 MAL), upper extremity portion of the Fugl-Meyer Motor Assessment, Graded Wolf Motor Function Test – for very low functioning patients (gWMFT- Grade 5), and Modified Ashworth Scale. The participant showed improvement on each outcome measure with the largest improvement on the Grade 5 MAL. In follow-up, the participant had good retention of his gains in motor performance and use of his more affected arm for real world activities after 3 months; after a one-week brush-up at 3 months, and at one year post-treatment. Show more

Keywords: CI therapy, stroke, occupational therapy, physical therapy, plegic hand

DOI: 10.3233/NRE-2006-21208

Citation: NeuroRehabilitation, vol. 21, no. 2, pp. 167-176, 2006