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Edward Taub - One of the best experts on this subject based on the ideXlab platform.
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constraint induced Movement Therapy for improving motor function of the paretic lower extremity after stroke
American Journal of Physical Medicine & Rehabilitation, 2020Co-Authors: Sarah Monteiro Dos Anjos, David M Morris, Edward TaubAbstract:A 56-yr-old woman with chronic stroke and gait dysfunction was recruited for this study. A lower-extremity Constraint-Induced Movement Therapy protocol was given consisting of 3.5 hrs/d of supervised intervention activities on 10 consecutive weekdays. Motor training was intensive and involved shaping. In addition, a group of behavior management strategies was used to induce further unsupervised practice and transference of motor skills from the laboratory to real-world situations. Changes in functional mobility, walking speed, balance, level of assistance, perceived quality of Movement, and level of confidence while performing daily activities were assessed five times in both the baseline and intervention phases. The outcomes observed after the intervention were determined by calculating the difference between the average scores obtained in both phases. Changes in perceived quality of Movement, level of confidence, level of assistance, and balance were observed.
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constraint induced Movement Therapy for lower extremity function describing the le cimt protocol
Physical Therapy, 2020Co-Authors: Sarah Dos Anjos, David M Morris, Edward TaubAbstract:Constraint-Induced Movement Therapy (CIMT) is comprised of a set of techniques shown to produce significant changes in upper extremity (UE) function following stroke and other disorders. The significant positive results obtained with the UE protocol have led to the development of LE-CIMT, an intervention to improve lower extremity (LE) function. However, some modifications of the UE protocol were needed, including omitting use of a restraint device, development of supervised motor training tasks to emphasize Movement of the lower limb, and adaptation of the UE Motor Activity Log for the lower extremity. The LE-CIMT protocol includes: (1) intensive supervised training delivered for 3.5 h/d for 10 consecutive weekdays, (2) use of shaping as a strategy for motor training, (3) application of a transfer package, and (4) strongly encouraging use of the more-affected LE with improved coordination. The transfer package consists of several strategies to facilitate transfer of the improved motor skills developed during supervised treatment to everyday situations. Research to date has yielded positive results. However, the intervention protocol continues to evolve. The purpose of this article is to describe the components of the complete LE-CIMT protocol to promote further development and investigation of this approach.
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phase ii randomized controlled trial of constraint induced Movement Therapy in multiple sclerosis part 1 effects on real world function
Neurorehabilitation and Neural Repair, 2018Co-Authors: Victor W. Mark, Edward Taub, Gitendra Uswatte, David M Morris, Gary Cutter, Terrie L Adams, Mary H Bowman, Staci MckayAbstract:Background. Constraint-Induced Movement Therapy (CIMT) has controlled evidence of efficacy for improving real-world paretic limb use in non-progressive physically disabling disorders (stroke, cereb...
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phase ii randomized controlled trial of constraint induced Movement Therapy in multiple sclerosis part 2 effect on white matter integrity
Neurorehabilitation and Neural Repair, 2018Co-Authors: Ameen Barghi, Edward Taub, Gitendra Uswatte, Jane B Allendorfer, Brent Womble, Jarrod M Hicks, Jerzy P Szaflarski, Victor W. MarkAbstract:Background. Constraint-Induced Movement Therapy (CIMT) is a method of physical rehabilitation that has demonstrated clinical efficacy in patients with chronic stroke, cerebral palsy, and multiple s...
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constraint induced Movement Therapy when efficacious motor Therapy meets progressive disease
Nutrition and Lifestyle in Neurological Autoimmune Diseases#R##N#Multiple Sclerosis, 2017Co-Authors: Ameen Barghi, Victor W. Mark, Edward TaubAbstract:Abstract Despite its being characterized in the late 1800s, multiple sclerosis (MS) continues to debilitate and burden patients and caregivers alike. With its root causes still unknown, this progressive neuropathology manifests in myriad symptoms and sclerotic central nervous system (CNS) lesions. This chapter outlines some of the hypothesized genetic and environmental causes, primary symptomatic elements, and clinical management techniques of MS. In particular, this chapter summarizes the history, components, and preliminary results of a form of physical rehabilitation, termed Constraint-Induced Movement Therapy (CI Therapy), which has preliminary evidence for success with improving real-world physical function as well as structural neuroplasticity of the CNS. We review prior neuroimaging findings of CI Therapy and describe potential mechanisms behind the treatment success. We suggest that this efficacious motor Therapy may have an important role for treating patients with progressive MS.
Steven L. Wolf - One of the best experts on this subject based on the ideXlab platform.
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An Application of Upper-Extremity Constraint-Induced Movement Therapy in a Patient With
2016Co-Authors: Subacute Stroke, Sarah Blanton, Steven L. WolfAbstract:Background and Purpose. The purpose of this case report is to demonstrate the application of Constraint-Induced Movement Therapy with an individual with upper-extremity hemiparesis within 4 months after sustaining a cerebrovascular accident (stroke). Such patients often fail to develop full potential use of their affected upper extrem-ity, perhaps due to a “learned nonuse phenomenon. ” Case Descrip-tion. The patient was a 61-year-old woman with right-sided hemiparesis resulting from an ischemic lacunar infarct in the posterior limb of the left internal capsule. The patient’s less-involved hand was constrained in a mitten so that she could not use the hand during waking hours, except for bathing and toileting. On each weekday of the 14-day intervention period, the patient spent 6 hours being supervised while performing tasks using the paretic upper extremity. Pretreatment, posttreatment, and 3-month follow-up outcome measures included the Wolf Motor Function Test and the Motor Activity Log (MAL). Out-comes. For the Wolf Motor FunctionTest, both the mean and median times to complete 16 tasks improved from pretreatment to posttreat-ment and from posttreatment to follow-up. Results of the MAL indicated an improved self-report of both “how well ” and “how much” the patient used her affected limb in 30 specified daily tasks. These improvements persisted to the follow-up. Discussion. Two weeks of constraining the unaffected limb, coupled with practice of functional Movements of the impaired limb, may be an effective method for restoring motor function within a few months after cerebral insult. Encouraging improvements such as these strongly suggest the need for a group design that would explore this type of intervention in more detail. [Blanton S, Wolf SL. An application of upper-extremity Constraint-Induced Movement Therapy in a patient with subacute stroke. Phys Ther. 1999;79:847–853.
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Constraint-Induced Movement Therapy (CIMT): current perspectives and future directions,” Stroke Research and Treatment
2016Co-Authors: Steven L. Wolf, Elder Care, Nell HodgAbstract:Constraint-Induced Movement Therapy (CIMT) has gained considerable popularity as a valuable treatment for a hemiparetic upper extremity. This approach is compatible with the emerging notion that task-oriented or functionally oriented retraining of the impaired limb provides evidence to support its utility. This article first provides a historical perspective on the development of CIMT. An overview model of how learned nonuse of the hemiparetic limb occurs and can be overcome with CIMT is discussed, and then a more detailed model that incorporates critical issues requiring considerably more basic and applied scientific exploration is described. Among the issues considered are the extent to which hemiparetic limb nonuse and subsequent modes of delivery to overcome it are governed by structure-function deficits rather than being attributable primarily to behavioral phenomena; the relative importance of the intensity of training; the need to better balance unimanual and bimanual upper-extremity task practice; the role of psychosocial and cultural factors in foster-ing patient compliance; the optimization of modes of delivery; and the reevaluation of the constellation of components contributing to successful outcomes with this treatment. Finally, the strengths, uncertainties, and limitations associated with CIMT are examined
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constraint induced Movement Therapy after stroke
Lancet Neurology, 2015Co-Authors: Gert Kwakkel, Erwin E H Van Wegen, Janne M Veerbeek, Steven L. WolfAbstract:Summary Constraint-Induced Movement Therapy (CIMT) was developed to overcome upper limb impairments after stroke and is the most investigated intervention for the rehabilitation of patients. Original CIMT includes constraining of the non-paretic arm and task-oriented training. Modified versions also apply constraining of the non-paretic arm, but not as intensive as original CIMT. Behavioural strategies are mostly absent for both modified and original CIMT. With forced use Therapy, only constraining of the non-paretic arm is applied. The original and modified types of CIMT have beneficial effects on motor function, arm–hand activities, and self-reported arm–hand functioning in daily life, immediately after treatment and at long-term follow-up, whereas there is no evidence for the efficacy of constraint alone (as used in forced use Therapy). The type of CIMT, timing, or intensity of practice do not seem to affect patient outcomes. Although the underlying mechanisms that drive modified and original CIMT are still poorly understood, findings from kinematic studies suggest that improvements are mainly based on adaptations through learning to optimise the use of intact end-effectors in patients with some voluntary motor control of wrist and finger extensors after stroke.
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constraint induced Movement Therapy cimt current perspectives and future directions
Stroke Research and Treatment, 2012Co-Authors: Aimee Reiss, Steven L. Wolf, Elizabeth A Hammel, Erin L Mcleod, Erin A WilliamsAbstract:Constraint-Induced Movement Therapy (CIMT) has gained considerable popularity as a treatment technique for upper extremity rehabilitation among patients with mild-to-moderate stroke. While substantial evidence has emerged to support its applicability, issues remain unanswered regarding the best and most practical approach. Following the establishment of what can be called the “signature” CIMT approach characterized by intense clinic/laboratory-based practice, several distributed forms of training, collectively known as modified constraint Therapy (mCIMT), have emerged. There is a need to examine the strengths and limitations of such approaches, and based upon such information, develop the components of a study that would compare the signature approach to the best elements of mCIMT, referred to here as “alternative” CIMT. Based upon a PEDro review of literature, limitations in mCIMT studies for meeting criteria were identified and discussed. A suggestion for a “first effort” at a comparative study that would both address such limitations while taking practical considerations into account is provided.
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constraint induced Movement Therapy cimt current perspectives and future directions
Stroke Research and Treatment, 2012Co-Authors: Aimee Reiss, Steven L. Wolf, Elizabeth A Hammel, Erin L Mcleod, Erin A WilliamsAbstract:Constraint-Induced Movement Therapy (CIMT) has gained considerable popularity as a treatment technique for upper extremity rehabilitation among patients with mild-to-moderate stroke. While substantial evidence has emerged to support its applicability, issues remain unanswered regarding the best and most practical approach. Following the establishment of what can be called the “signature” CIMT approach characterized by intense clinic/laboratory-based practice, several distributed forms of training, collectively known as modified constraint Therapy (mCIMT), have emerged. There is a need to examine the strengths and limitations of such approaches, and based upon such information, develop the components of a study that would compare the signature approach to the best elements of mCIMT, referred to here as “alternative” CIMT. Based upon a PEDro review of literature, limitations in mCIMT studies for meeting criteria were identified and discussed. A suggestion for a “first effort” at a comparative study that would both address such limitations while taking practical considerations into account is provided.
Gitendra Uswatte - One of the best experts on this subject based on the ideXlab platform.
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phase ii randomized controlled trial of constraint induced Movement Therapy in multiple sclerosis part 1 effects on real world function
Neurorehabilitation and Neural Repair, 2018Co-Authors: Victor W. Mark, Edward Taub, Gitendra Uswatte, David M Morris, Gary Cutter, Terrie L Adams, Mary H Bowman, Staci MckayAbstract:Background. Constraint-Induced Movement Therapy (CIMT) has controlled evidence of efficacy for improving real-world paretic limb use in non-progressive physically disabling disorders (stroke, cereb...
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phase ii randomized controlled trial of constraint induced Movement Therapy in multiple sclerosis part 2 effect on white matter integrity
Neurorehabilitation and Neural Repair, 2018Co-Authors: Ameen Barghi, Edward Taub, Gitendra Uswatte, Jane B Allendorfer, Brent Womble, Jarrod M Hicks, Jerzy P Szaflarski, Victor W. MarkAbstract:Background. Constraint-Induced Movement Therapy (CIMT) is a method of physical rehabilitation that has demonstrated clinical efficacy in patients with chronic stroke, cerebral palsy, and multiple s...
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treatment of congenital hemiparesis with pediatric constraint induced Movement Therapy
Journal of Child Neurology, 2011Co-Authors: Edward Taub, Gitendra Uswatte, Angi Griffin, Kristin Gammons, Jennifer Nick, Charles R LawAbstract:To determine efficacy of pediatric Constraint-Induced Movement Therapy, 20 children with congenital hemiparesis (ages 2 to 6 years) were randomly assigned to receive the treatment or usual care. Controls crossed over to the Therapy after 6 months. Children receiving the Therapy first exhibited emergence of more new classes of motor patterns and skills (eg, crawling, thumb-forefinger prehension; 6.4 vs 0.02, P < .0001, effect size d = 1.3), and demonstrated significant gains in spontaneous use of the more affected arm at home (2.2 vs 0.1, P < .0001, d = 3.8) and in a laboratory motor function test. Depending on the measure, benefits were maintained (range, no loss to 68% retention over 6 months). When controls crossed over to the Therapy, they exhibited improvements as great as or greater than those receiving Therapy first. Thus, Constraint-Induced Movement Therapy appears to be efficacious for young children with hemiparesis consequent to congenital stroke.
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the excite stroke trial comparing early and delayed constraint induced Movement Therapy
Stroke, 2010Co-Authors: Steven L. Wolf, Edward Taub, Sarah Blanton, Gitendra Uswatte, David M Morris, Deborah S Nicholslarsen, Paul Thompson, Carolee J Winstein, Phillip J Miller, Kathye E LightAbstract:Background and Purpose—Although Constraint-Induced Movement Therapy (CIMT) has been shown to improve upper extremity function in stroke survivors at both early and late stages after stroke, the comparison between participants within the same cohort but receiving the intervention at different time points has not been undertaken. Therefore, the purpose of this study was to compare functional improvements between stroke participants randomized to receive this intervention within 3 to 9 months (early group) to participants randomized on recruitment to receive the identical intervention 15 to 21 months after stroke (delayed group). Methods—Two weeks of CIMT was delivered to participants immediately after randomization (early group) or 1 year later (delayed group). Evaluators blinded to group designation administered primary (Wolf Motor Function Test, Motor Activity Log) and secondary (Stroke Impact Scale) outcome measures among the 106 early participants and 86 delayed participants before delivery of CIMT, 2 w...
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constraint induced Movement Therapy a paradigm for translating advances in behavioral neuroscience into rehabilitation treatments
Handbook of Neuroscience for the Behavioral Sciences, 2009Co-Authors: Edward Taub, Gitendra UswatteAbstract:1 Behavioral Plasticity After Somatosensory Deafferentation in Monkeys 2 A Linked, but Independent, Mechanism: Use-Dependent Plastic Brain Reorganization 3 Application of the Learned Nonuse Model to Humans After Stroke 4 Application of CI Therapy to the Treatment of Other Neurological and Orthopedic Disorders 5 An Impending Paradigm Shift Keywords: neuroplasticity; neurorehabilitation; CI Therapy; Constraint-Induced Movement Therapy; Movement; stroke; traumatic brain injury; cerebral palsy; multiple sclerosis; intensive training; shaping; transfer package; treatment; translational research
Victor W. Mark - One of the best experts on this subject based on the ideXlab platform.
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phase ii randomized controlled trial of constraint induced Movement Therapy in multiple sclerosis part 1 effects on real world function
Neurorehabilitation and Neural Repair, 2018Co-Authors: Victor W. Mark, Edward Taub, Gitendra Uswatte, David M Morris, Gary Cutter, Terrie L Adams, Mary H Bowman, Staci MckayAbstract:Background. Constraint-Induced Movement Therapy (CIMT) has controlled evidence of efficacy for improving real-world paretic limb use in non-progressive physically disabling disorders (stroke, cereb...
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phase ii randomized controlled trial of constraint induced Movement Therapy in multiple sclerosis part 2 effect on white matter integrity
Neurorehabilitation and Neural Repair, 2018Co-Authors: Ameen Barghi, Edward Taub, Gitendra Uswatte, Jane B Allendorfer, Brent Womble, Jarrod M Hicks, Jerzy P Szaflarski, Victor W. MarkAbstract:Background. Constraint-Induced Movement Therapy (CIMT) is a method of physical rehabilitation that has demonstrated clinical efficacy in patients with chronic stroke, cerebral palsy, and multiple s...
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constraint induced Movement Therapy when efficacious motor Therapy meets progressive disease
Nutrition and Lifestyle in Neurological Autoimmune Diseases#R##N#Multiple Sclerosis, 2017Co-Authors: Ameen Barghi, Victor W. Mark, Edward TaubAbstract:Abstract Despite its being characterized in the late 1800s, multiple sclerosis (MS) continues to debilitate and burden patients and caregivers alike. With its root causes still unknown, this progressive neuropathology manifests in myriad symptoms and sclerotic central nervous system (CNS) lesions. This chapter outlines some of the hypothesized genetic and environmental causes, primary symptomatic elements, and clinical management techniques of MS. In particular, this chapter summarizes the history, components, and preliminary results of a form of physical rehabilitation, termed Constraint-Induced Movement Therapy (CI Therapy), which has preliminary evidence for success with improving real-world physical function as well as structural neuroplasticity of the CNS. We review prior neuroimaging findings of CI Therapy and describe potential mechanisms behind the treatment success. We suggest that this efficacious motor Therapy may have an important role for treating patients with progressive MS.
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improvement after constraint induced Movement Therapy is independent of infarct location in chronic stroke patients
Stroke, 2009Co-Authors: Lynne V Gauthier, Edward Taub, Victor W. Mark, Christi Perkins, Gitendra UswatteAbstract:Background and Purpose— Disruption of the corticospinal tract at various locations in the brain has been shown to predict worse spontaneous motor recovery after stroke. However, the anatomic specificity of previous findings was limited by the categorical classification of infarct locations. Here we used computational methods to more precisely determine the specific anatomic locations associated with impaired motor ability. More important, however, our study also used these techniques to evaluate whether infarct location could influence motor outcomes after Constraint-Induced Movement Therapy (CI Therapy), a specific and controlled form of physical Therapy. Methods— Quantitative voxel-based analyses were used to determine whether infarct location could predict either initial motor ability or clinical improvement after CI Therapy in chronic stroke patients. Results— Although corona radiata infarcts were associated with worse in-laboratory motor ability at pretreatment, infarct location did not predict impro...
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constraint induced Movement Therapy can improve hemiparetic progressive multiple sclerosis preliminary findings
Multiple Sclerosis Journal, 2008Co-Authors: Victor W. Mark, Edward Taub, Gitendra Uswatte, Mary H Bowman, Staci Mckay, Khurram Bashir, Adriana Delgado, Camille Bryson, Gary CutterAbstract:ObjectiveTo evaluate whether Constraint-Induced Movement Therapy (CI Therapy) may benefit chronic upper extremity hemiparesis in progressive multiple sclerosis (MS).MethodsFive patients with progressive MS, who had chronic upper extremity hemiparesis and evidence for learned non-use of the paretic limb in the life situation, underwent 30 hours of repetitive task training and shaping for the paretic limb over 2–10 consecutive weeks, along with physical restraint of the less-affected arm and a “transfer package” of behavioral techniques to reinforce treatment adherence.ResultsThe patients showed significantly improved spontaneous, real-world limb use at post-treatment and 4 weeks post-treatment, along with improved fatigue ratings and maximal Movement ability displayed in a laboratory motor test.Conclusions The findings suggest for the first time that slowly progressive MS may benefit from CI Therapy. Further studies are needed to determine the retention of treatment responses.
David M Morris - One of the best experts on this subject based on the ideXlab platform.
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constraint induced Movement Therapy for improving motor function of the paretic lower extremity after stroke
American Journal of Physical Medicine & Rehabilitation, 2020Co-Authors: Sarah Monteiro Dos Anjos, David M Morris, Edward TaubAbstract:A 56-yr-old woman with chronic stroke and gait dysfunction was recruited for this study. A lower-extremity Constraint-Induced Movement Therapy protocol was given consisting of 3.5 hrs/d of supervised intervention activities on 10 consecutive weekdays. Motor training was intensive and involved shaping. In addition, a group of behavior management strategies was used to induce further unsupervised practice and transference of motor skills from the laboratory to real-world situations. Changes in functional mobility, walking speed, balance, level of assistance, perceived quality of Movement, and level of confidence while performing daily activities were assessed five times in both the baseline and intervention phases. The outcomes observed after the intervention were determined by calculating the difference between the average scores obtained in both phases. Changes in perceived quality of Movement, level of confidence, level of assistance, and balance were observed.
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constraint induced Movement Therapy for lower extremity function describing the le cimt protocol
Physical Therapy, 2020Co-Authors: Sarah Dos Anjos, David M Morris, Edward TaubAbstract:Constraint-Induced Movement Therapy (CIMT) is comprised of a set of techniques shown to produce significant changes in upper extremity (UE) function following stroke and other disorders. The significant positive results obtained with the UE protocol have led to the development of LE-CIMT, an intervention to improve lower extremity (LE) function. However, some modifications of the UE protocol were needed, including omitting use of a restraint device, development of supervised motor training tasks to emphasize Movement of the lower limb, and adaptation of the UE Motor Activity Log for the lower extremity. The LE-CIMT protocol includes: (1) intensive supervised training delivered for 3.5 h/d for 10 consecutive weekdays, (2) use of shaping as a strategy for motor training, (3) application of a transfer package, and (4) strongly encouraging use of the more-affected LE with improved coordination. The transfer package consists of several strategies to facilitate transfer of the improved motor skills developed during supervised treatment to everyday situations. Research to date has yielded positive results. However, the intervention protocol continues to evolve. The purpose of this article is to describe the components of the complete LE-CIMT protocol to promote further development and investigation of this approach.
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phase ii randomized controlled trial of constraint induced Movement Therapy in multiple sclerosis part 1 effects on real world function
Neurorehabilitation and Neural Repair, 2018Co-Authors: Victor W. Mark, Edward Taub, Gitendra Uswatte, David M Morris, Gary Cutter, Terrie L Adams, Mary H Bowman, Staci MckayAbstract:Background. Constraint-Induced Movement Therapy (CIMT) has controlled evidence of efficacy for improving real-world paretic limb use in non-progressive physically disabling disorders (stroke, cereb...
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the excite stroke trial comparing early and delayed constraint induced Movement Therapy
Stroke, 2010Co-Authors: Steven L. Wolf, Edward Taub, Sarah Blanton, Gitendra Uswatte, David M Morris, Deborah S Nicholslarsen, Paul Thompson, Carolee J Winstein, Phillip J Miller, Kathye E LightAbstract:Background and Purpose—Although Constraint-Induced Movement Therapy (CIMT) has been shown to improve upper extremity function in stroke survivors at both early and late stages after stroke, the comparison between participants within the same cohort but receiving the intervention at different time points has not been undertaken. Therefore, the purpose of this study was to compare functional improvements between stroke participants randomized to receive this intervention within 3 to 9 months (early group) to participants randomized on recruitment to receive the identical intervention 15 to 21 months after stroke (delayed group). Methods—Two weeks of CIMT was delivered to participants immediately after randomization (early group) or 1 year later (delayed group). Evaluators blinded to group designation administered primary (Wolf Motor Function Test, Motor Activity Log) and secondary (Stroke Impact Scale) outcome measures among the 106 early participants and 86 delayed participants before delivery of CIMT, 2 w...
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constraint induced Movement Therapy characterizing the intervention protocol
European Journal of Physical and Rehabilitation Medicine, 2006Co-Authors: David M Morris, Edward Taub, Victor W. MarkAbstract:Constraint-Induced Movement Therapy (CI Therapy) is a rehabilitation treatment approach that improves more-affected extremity use following a stroke, especially in the life situation. The originators of the approach describe CI Therapy as consisting of a family of therapies including a number of treatment components and subcomponents. When thinking of CI Therapy, rehabilitation researchers and clinicians frequently cite a restraining mitt on the less affected arm as the main active ingredient behind improvements in motor function. However, substantial data suggest that restraint makes actually a relatively small contribution to treatment outcome. This paper provides a detailed description of the multiple treatment elements included in the CI Therapy protocol as used in our research laboratory. Our aim is to improve understanding of CI Therapy and the research supporting its use.