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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 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.
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constraint induced Movement Therapy results in increased motor map area in subjects 3 to 9 months after stroke
Neurorehabilitation and Neural Repair, 2008Co-Authors: Lumy Sawaki, Steven L. Wolf, Sarah Blanton, Andrew J Butler, Xiaoyan Leng, Peter A Wassenaar, Yousef Mohammad, K Sathian, Deborah S NicholslarsenAbstract:Background. Constraint-induced Movement Therapy (CIMT) has received considerable attention as an intervention to enhance motor recovery and cortical reorganization after stroke. Objective. The pres...
Edward Taub - 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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The behavior-analytic origins of constraint-induced Movement Therapy: An example of behavioral neurorehabilitation
The Behavior Analyst, 2012Co-Authors: Edward TaubAbstract:Constraint-induced (CI) Therapy is a term given to a family of efficacious neurorehabilitation treatments including to date: upper extremity CI Movement Therapy, lower extremity CI Movement Therapy, pediatric CI Therapy, and CI aphasia Therapy. The purpose of this article is to outline the behavior analysis origins of CI Therapy and the ways in which its procedures incorporate behavior analysis methods and principles. The intervention is founded on the concept of learned nonuse , a mechanism now empirically demonstrated to exist, which occurs after many different types of damage to the central nervous system (CNS). It results from the dramatic alteration of the contingencies of reinforcement that results from substantial CNS damage and leads to a greater deficit than is warranted by the actual damage sustained. CI Therapy produces a countervailing alteration in the contingencies of reinforcement. The intervention has been used successfully to substantially improve motor deficits after stroke, traumatic brain injury, spinal cord injury, multiple sclerosis, with cerebral palsy in a pediatric population, and for language impairment in poststroke aphasia. The protocol of CI Therapy consists primarily of standard behavior-analytic methods. It produces a marked plastic brain change that is correlated with its therapeutic effect, and therefore provides an example of the way in which behavior change can contribute to a profound remodeling of the brain. CI Therapy may be viewed as an example of behavioral neurorehabilitation.
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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.
Erin A Williams - One of the best experts on this subject based on the ideXlab platform.
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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.
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 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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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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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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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.
Aimee Reiss - One of the best experts on this subject based on the ideXlab platform.
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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.