Constraint Induced Therapy (CIT), a novel approach to rehabilitating upper limb hemiparesis in individuals post-stroke, has received a great deal of attention at national physical therapy conferences, scientific meetings, and several nationally televised broadcasts. CIT consists primarily of 2 necessary components: 1. constraint, using a sling, mitt or glove, of the unimpaired upper limb and 2. intense unilateral task practice with the hemiparetic upper limb. Taub and colleagues and Wolf et al. have produced evidence for the benefits of CIT for an exclusive group of individuals who have had a single stroke, met specific minimal motor criteria, and are at least 1 year post stroke. Controversy surrounds the requirement of the constraint and the intensity of the therapy. Perhaps similar recovery levels are possible without constraint of the unimpaired limb and with less intense, economically practical therapy. Certainly, replication and objectivity are needed to verify the benefits of CIT, to ask specific questions about the assumptions, and to identify the necessary treatment parameters. The purpose of this proposal is to ask questions related to constraint and intensity. The 3 specific aims are 1. to determine if CIT results in better outcomes than unconstrained functional training of equivalent time intensity and task structure, 2. to determine if CIT, provided by on site trainers, results in better outcomes than a combination of brief on-site training followed by home training and telephone supervision, and 3. to determine if a booster session of CIT intervention results in significantly improved functional gains.
| Massie, Crystal; Malcolm, Matthew P; Greene, David et al. (2009) The effects of constraint-induced therapy on kinematic outcomes and compensatory movement patterns: an exploratory study. Arch Phys Med Rehabil 90:571-9 |
