Repetitive task practice: a critical review of constraint-induced movement therapy in stroke

Abstract

Background: Constraint-induced (CI) movement therapy (also called forced use by some investigators and clinicians) has gained increasing popularity as a treatment mode for restoring function in the upper extremities of patients with stroke. The purpose of this article is to review the concept of constraint-induced movement therapy and provide a critical analysis of the existing data.

Review summary: The evidence to date offers encouragement for the application of this procedure for patients who have some movement recovery out of synergy. Success may be contingent on patient cooperation and intense repetitive use with applications of retraining through practice and shaping. The extent to which each of the latter elements influences the magnitude of recovery is still unclear. However, task novelty and challenge seem important to recovery of function. There are several methods used to map cortical changes after stroke. At this time, transcranial magnetic stimulation is the primary vehicle used to assess motor cortical reorganization after CI therapy in humans.

Conclusions: Accumulating data indicate that the size of a cortical area representative of a muscle does expand and its center of gravity does change with CI therapy.

Figure 1

Schematic model for the development of learned nonuse. Reprinted with permission from Carlson JG, Seifert AR, Birbaumer N. Clinical Applied Psychophysiology. New York: Plenum Press; 1994:192.

Figure 2

Schematic model of mechanism for overcoming learned nonuse. Reprinted with permission from Carlson JG, Seifert AR, Birbaumer N. Clinical Applied Psychophysiology. New York: Plenum Press; 1994:192.