December 4, 2014

Constraint Therapy is Good and Bad

When a student told a blogger stroke recovery happens only in the first two years I decided to write about constraint therapy.  It was designed by Edward Taub who did not believe recovery after a stroke is time limited.  Constraint therapy involves 1+ hours of therapy that focuses exclusively on the hemiplegic hand plus leaving a mitt on the sound hand for 3+ hours at home each day to force the hemiplegic hand to work.

Constraint therapy is good because it challenged long held beliefs about neuroplasticity.
Constraint therapy is bad because it is appropriate for a limited pool of clients.  1) Stroke survivors must already be able to extend (straighten) their fingers 10 degrees and their wrist 20 degrees.
2) It is good for men who have women to take care of them.  It would be nice if every husband did all the chores at home while wives constrain their sound hand at home every day.  3) Some stroke survivors experience crushing fatigue which would make this intense program difficult.

Current research offers an alternative.  Hayner found guiding both hands to work while making lunch, eating, and cleaning up helped stroke survivors improve as much as subjects whose hand was constrained during the same activity (1).  Sterr reported that stroke survivors who were helped to use their hemiplegic hand for 90 or 180 minutes improved as much as subjects who received constraint therapy for the same amount of time (2).  These and other studies have shown that practice which is less intense and comes in several forms can produce recovery.  

I get intense practice by doing exercises with a spring-loaded SaeboFlex splint that helps me open my hand 100 times.  I live alone so I am glad these exercises have helped my hemiplegic hand open to hold 100+ objects while my sound hand manipulates those objects.  In 11 years my hemiplegic hand has opened to hold a tube of toothpaste 16,060 times so my sound hand can take the cap off and open again when I put the cap back on after I put toothpaste on my toothbrush.

Bottom Line: Taub showed therapists and stroke survivors they need to let go of old myths.

1. Hayner K, Gibson G, Giles G. Comparison of constraint-induced therapy and bilateral treatment
    of equal intensity in people with chronic upper-extremity dysfunction after cardiovascular    
    accident.  American Journal of Occupational Therapy. 2010;64(4):528-539.
2.  Sterr A, Oneill D, Dean P, Herron K.  CI therapy is beneficial to patients with chronic low-
     functioning hemiparesis after stroke. Front. Neurol. 2014;5:

1 comment:

  1. My experience was that forced use required me to recover. I had to take care of my son. I needed two hands to do what I needed to do. My hand/arm is not perfectly functioning but it is functional enough to do what I need to do most of the time. Luck? Maybe. Forced use? Yes!