Stroke afflicts over 700,000 persons in America every year. There is thus an urgent need to translate unique behavioral techniques shown to have an impact on plasticity of the nervous system into practical evidence-based therapeutic interventions, especially at a time when the duration of treatments has shortened. In this laboratory we have developed on such set of techniques derived from basic research with an8mal and human subjects. Randomized, controlled studies indicate that it can substantially reduce the motor deficit of patients with mild to moderate chronic strokes from the upper two quartiles of motor functioning and can increase their independence over a period of years. The techniques, termed Constrain- Induced (CI) Movement Therapy, involve motor restriction of the less affected upper extremity for a period of two or three weeks while at the same time training the more affected upper limb. This gives rise to massed or repetitive use of the more affected extremity and to a large increase in use-dependent cortical reorganization involving the recruitment of substantial new regions of the brain in the innervation of more-affected extremity movement. One of the main aims of the proposed research is to determine if Cl Therapy can be used with therapeutic success for increasing the amount of real work extremity use in patients with chronic stroke who have a greater level of motor impairment than those previously worked with in this laboratory (i.e., patients who are approximately in the next to lowest quartile of motor functioning). Another aim is to ascertain whether the locus of the lesion and its size as determined by MRI, are factors influencing the extent to which motor function can be recovered through the use of CI Therapy. This prospective, 4-year randomized trial, including 18-month follow-up will use a crossover design. Eight patients with chronic stroke from the next to lowest quartile of motor functioning will be randomly assigned to receive either Cl therapy (40 subjects) or a General Fitness placebo control intervention (40 subjects). Two years after intake the control patients will be crossed over to receive Cl Therapy. Primary outcome measures will be a laboratory motor function test and amount of extremity use in the real world setting. Changes in psychosocial functioning will also be measured.

Agency
National Institute of Health (NIH)
Institute
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Type
Research Project (R01)
Project #
2R01HD034273-04
Application #
2903566
Study Section
Geriatrics and Rehabilitation Medicine (GRM)
Program Officer
Ansel, Beth
Project Start
1996-12-09
Project End
2003-11-30
Budget Start
2000-02-10
Budget End
2000-11-30
Support Year
4
Fiscal Year
2000
Total Cost
$313,337
Indirect Cost
Name
University of Alabama Birmingham
Department
Psychology
Type
Schools of Arts and Sciences
DUNS #
004514360
City
Birmingham
State
AL
Country
United States
Zip Code
35294
Haddad, Michelle M; Uswatte, Gitendra; Taub, Edward et al. (2017) Relation of depressive symptoms to outcome of CI movement therapy after stroke. Rehabil Psychol 62:509-515
Rickards, Tyler; Sterling, Chelsey; Taub, Edward et al. (2014) Diffusion tensor imaging study of the response to constraint-induced movement therapy of children with hemiparetic cerebral palsy and adults with chronic stroke. Arch Phys Med Rehabil 95:506-514.e1
Gauthier, Lynne V; Mark, Victor W; Taub, Edward et al. (2014) Motor recovery from constraint induced movement therapy is not constrained by extent of tissue damage following stroke. Restor Neurol Neurosci 32:755-65
Taub, Edward; Uswatte, Gitendra; Mark, Victor W et al. (2013) Method for enhancing real-world use of a more affected arm in chronic stroke: transfer package of constraint-induced movement therapy. Stroke 44:1383-8
Taub, Edward; Uswatte, Gitendra; Bowman, Mary H et al. (2013) Constraint-induced movement therapy combined with conventional neurorehabilitation techniques in chronic stroke patients with plegic hands: a case series. Arch Phys Med Rehabil 94:86-94
Taub, Edward (2012) The behavior-analytic origins of constraint-induced movement therapy: an example of behavioral neurorehabilitation. Behav Anal 35:155-78
Taub, Edward (2012) Parallels between use of constraint-induced movement therapy to treat neurological motor disorders and amblyopia training. Dev Psychobiol 54:274-92
Gauthier, Lynne V; Taub, Edward; Mark, Victor W et al. (2012) Atrophy of spared gray matter tissue predicts poorer motor recovery and rehabilitation response in chronic stroke. Stroke 43:453-7
Uswatte, Gitendra; Hobbs Qadri, Laura (2009) A behavioral observation system for quantifying arm activity in daily life after stroke. Rehabil Psychol 54:398-403
Gauthier, Lynne V; Taub, Edward; Mark, Victor W et al. (2009) Improvement after constraint-induced movement therapy is independent of infarct location in chronic stroke patients. Stroke 40:2468-72

Showing the most recent 10 out of 30 publications