Abstract
Stroke resulting in motor dysfunction can lead to functional impairment and reduced quality of life. Upper extremity involvement may lead to learned nonuse where the individual avoids using the affected limb after repeated failed attempts to incorporate it into functional activities. Constraint induced movement therapy (CIMT) is designed to counteract learned nonuse by limiting reliance on the unaffected upper extremity and structuring activities to promote primary use of the affected side. Numerous CIMT protocols have evolved that vary in duration and intensity; these have been found to impact motor recovery throughout the acute, subacute, and chronic phases post-stroke. However, despite this evidence, CIMT has not been routinely incorporated into clinical care due to barriers, including high resource intensity and time commitment as well as the potential for poor patient tolerance. In response to these concerns, current research explores the efficacy of CIMT when administered in non-traditional settings including group-based interventions and remote therapy programs where supervision is provided most commonly by a family member or other caregiver.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Taub E. Movement in nonhuman primates deprived of somatosensory feedback. Exerc Sport Sci Rev. 1976;4:335–74.
Morris DM, Taub E, Mark VW. Constraint-induced movement therapy: characterizing the intervention protocol. Eura Medicophys. 2006;42(3):257–68.
Taub E, Crago J, Uswatte G. Constraint-induced movement therapy: a new approach to treatment in physical rehabilitation. Rehabil Psychol. 1998;43(2):152–70.
Wolf SL, et al. Effect of constraint-induced movement therapy on upper extremity function 3 to 9 months after stroke: the EXCITE randomized clinical trial. JAMA. 2006;296(17):2095–104.
Page SJ, et al. Modified constraint-induced therapy in chronic stroke: results of a single-blinded randomized controlled trial. Phys Ther. 2008;88(3):333–40.
Page SJ, Levine P, Khoury JC. Modified constraint-induced therapy combined with mental practice: thinking through better motor outcomes. Stroke. 2009;40(2):551–4.
Page SJ, et al. Efficacy of modified constraint-induced movement therapy in chronic stroke: a single-blinded randomized controlled trial. Arch Phys Med Rehabil. 2004;85(1):14–8.
Shi YX, et al. Modified constraint-induced movement therapy versus traditional rehabilitation in patients with upper-extremity dysfunction after stroke: a systematic review and meta-analysis. Arch Phys Med Rehabil. 2011;92(6):972–82.
Yen J-G, et al. Effectiveness of modified constraint-induced movement therapy on upper limb function in stroke subjects. Acta Neurol Taiwanica. 2005;14(1):16–20.
Dettmers C, et al. Distributed form of constraint-induced movement therapy improves functional outcome and quality of life after stroke. Arch Phys Med Rehabil. 2005;86(2):204–9.
Taub E, et al. The learned nonuse phenomenon: implications for rehabilitation. Eura Medicophys. 2006;42:241–55.
Liepert J, et al. Treatment-induced cortical reorganization after stroke in humans. Stroke. 2000;31(6):1210–6.
Gauthier LV, et al. Remodeling the brain: plastic structural brain changes produced by different motor therapies after stroke. Stroke. 2008;39(5):1520–5.
Lin KC, et al. Constraint-induced therapy versus control intervention in patients with stroke: a functional magnetic resonance imaging study. Am J Phys Med Rehabil. 2010;89(3):177–85.
Murayama T, et al. Changes in the brain activation balance in motor-related areas after constraint-induced movement therapy; a longitudinal fMRI study. Brain Inj. 2011;25(11):1047–57.
Purkayastha S, Sorond F. Transcranial Doppler ultrasound: technique and application. Semin Neurol. 2012;32(4):411–20.
Treger I, et al. Constraint-induced movement therapy alters cerebral blood flow in subacute post-stroke patients. Am J Phys Med Rehabil. 2012;91(9):804–9.
Brogardh C, Lexell J. A 1-year follow-up after shortened constraint-induced movement therapy with and without mitt poststroke. Arch Phys Med Rehabil. 2010;91(3):460–4.
Uswatte G, et al. Contribution of the shaping and restraint components of constraint-induced movement therapy to treatment outcome. NeuroRehabilitation. 2006;21:147–56.
Brogårdh C, Sjölund BH. Constraint-induced movement therapy in patients with stroke: a pilot study on effects of small group training and of extended mitt use. Clin Rehabil. 2006;20(3):218–27.
Viana R, Teasell R. Barriers to the implementation of constraint-induced movement therapy into practice. Top Stroke Rehabil. 2012;19(2):104–14.
Hayner K, Gibson G, Giles GM. Comparison of constraint-induced movement therapy and bilateral treatment of equal intensity in people with chronic upper-extremity dysfunction after cerebrovascular accident. Am J Occup Ther. 2010;64(4):528–39.
Brunner IC, Skouen JS, Strand LI. Is modified constraint-induced movement therapy more effective than bimanual training in improving arm motor function in the subacute phase post stroke? A randomized controlled trial. Clin Rehabil. 2012;26(12):1078–86.
Stevenson T, et al. Constraint-induced movement therapy compared to dose-matched interventions for upper-limb dysfunction in adult survivors of stroke: a systematic review with meta-analysis. Physiother Can. 2012;64(4):397–413.
Sirtori V, et al. Constraint-induced movement therapy for upper extremities in stroke patients (review). Cochrane Database Syst Rev. 2009;4:CD004433.
Corbetta D, et al. Constraint-induced movement therpy in stroke patients: systematic review and meta-analysis. Eur J Phys Rehabil Med. 2010;45:537–44.
Kunkel A, et al. Constraint-induced movement therapy for motor recovery in chronic stroke patients. Arch Phys Med Rehabil. 1999;80:624–8.
Massie C, et al. The effects of constraint-induced therapy on kinematic outcomes and compensatory movement patterns: an exploratory study. Arch Phys Med Rehabil. 2009;90(4):571–9.
Taub E, Uswatte G. Constraint-induced movement therapy: answers and questions after two decades of research. NeuroRehabilitation. 2006;21:93–5.
Miltner WHR, et al. Effects of constraint-induced movement therapy on patients with chronic motor deficits after stroke: a replication. Stroke. 1999;30:586–92.
Blanton S, Wolf SL. An application of upper-extremity constraint-induced movement therapy in a patient with subacute stroke. Phys Ther. 1999;79(9):847–53.
Rowe VT, Blanton S, Wolf SL. Long-term follow-up after constraint-induced therapy: a case report of a chronic stroke survivor. Am J Occup Ther. 2009;63:317–22.
Brogardh C, Flansbjer U-B. What is the long-term benefit of constraint-induced movement therapy? A four-year follow-up. Clin Rehabil. 2009;23:418–23.
Dahl AE, et al. Short- and long-term outcome of constraint-induced movement therapy after stroke: a randomized controlled feasibility trial. Clin Rehabil. 2008;22(5):436–47.
Taub E, et al. Method for enhancing real-world use of a more affected arm in chronic stroke: transfer package of constraint-induced movement therapy. Stroke. 2013;44(5):1383–8.
Takebayashi T, et al. A 6-month follow-up after constraint-induced movement therapy with and without transfer package for patients with hemiparesis after stroke: a pilot quasi-randomized controlled trial. Clin Rehabil. 2013;27(5):418–26.
Broeks JG, et al. The long-term outcome of arm function after stroke: results of a follow-up study. Disabil Rehabil. 1999;21(8):357–64.
McIntyre A, et al. Systematic review and meta-analysis of constraint-induced movement therapy in the hemiparetic upper extremity more than six months post stroke. Top Stroke Rehabil. 2012;19(6):499–513.
Hiraoka K. Rehabilitation effort to improve upper extremity function post-stroke: a meta-analysis. J Phys Ther Sci. 2001;13:5–9.
Page SJ, Levine P, Leonard AC. Modified constraint-induced therapy in acute stroke: a randomized controlled pilot study. Neurorehabil Neural Repair. 2005;19(1):27–32.
Boake C, et al. Constraint-induced movement therapy during early stroke rehabilitation. Neurorehabil Neural Repair. 2007;21(1):14–24.
Dromerick AW, Edwards DF, Hahn M. Does the application of constraint-induced movement therapy during acute rehabilitation reduce arm impairment after ischemic stroke? Stroke. 2000;31:2984–8.
El-Helow M, et al. Efficacy of modified constraint-induced movement therapy in acute stroke. Eur J Phys Rehabil Med. 2015;51:371–9.
Thrane G, et al. Efficacy of constraint-induced movement therapy in early stroke rehabilitation. Neurorehabil Neural Repair. 2014;29(6):517–25.
Kwakkel G, et al. Effects of unilateral upper limb training in two distinct prognostic groups early after stroke. Neurorehabil Neural Repair. 2016;30(9):804–16.
Dromerick AW, et al. Very early constraint-induced movement during stroke rehabilitation (VECTORS): a single-center RCT. Neurology. 2009;73:195–201.
Wolf SL, et al. The EXCITE stroke trial: comparing early and delayed constraint-induced movement therapy. Stroke. 2010;41(10):2309–15.
Siebers A, Oberg U, Skargren E. The effect of modified constraint-induced movement therapy on spasticity and motor function of the affected arm in patients with chronic stroke. Physiother Can. 2010;62(4):388–96.
Sun SF, et al. Application of combined botulinum toxin type A and modified constraint-induced movement therapy for an individual with chronic upper-extremity spasticity after stroke. Phys Ther. 2006;86(10):1387–97.
Taub E, et al. Constraint-induced movement therapy combined with conventional neurorehabilitation techniques in chronic stroke patients with plegic hands: a case series. Arch Phys Med Rehabil. 2013;94(1):86–94.
Wu CY, et al. A randomized controlled trial of modified constraint-induced movement therapy for elderly stroke survivors: changes in motor impairment, daily functioning, and quality of life. Arch Phys Med Rehabil. 2007;88(3):273–8.
Boe EW, et al. Cognitive status does not predict motor gain from post stroke constraint-induced movement therapy. NeuroRehabilitation. 2014;34(1):201–7.
Bonifer NM, Anderson KM, Arciniegas DB. Constraint-induced therapy for moderate chronic upper extremity impairment after stroke. Brain Inj. 2005;19(5):323–30.
Page SJ, et al. Stroke patients’ and therapists’ opinions of constraint-induced movement therapy. Clin Rehabil. 2002;16(1):55–60.
Pedlow K, Lennon S, Wilson C. Application of constraint-induced movement therapy in clinical practice: an online survey. Arch Phys Med Rehabil. 2014;95(2):276–82.
Underwood J, et al. Pain, fatigue, and intensity of practice in people with stroke who are receiving constraint-induced movement therapy. Phys Ther. 2006;86(9):1241–50.
Leung DP, Ng AK, Fong KN. Effect of small group treatment of the modified constraint induced movement therapy for clients with chronic stroke in a community setting. Hum Mov Sci. 2009;28(6):798–808.
Henderson CA, Manns PJ. Group modified constraint-induced movement therapy (mCIMT) in a clinical setting. Disabil Rehabil. 2012;34(25):2177–83.
Doussoulin A, et al. Recovering functional independence after a stroke through modified constraint-induced therapy. NeuroRehabilitation. 2017;40(2):243–9.
Barzel A, et al. Comparison of two types of constraint-induced movement therapy in chronic stroke patients: a pilot study. Restor Neurol Neurosci. 2009;27(6):673–80.
Barzel A, et al. Home-based constraint-induced movement therapy for patients with upper limb dysfunction after stroke (HOMECIMT): a cluster-randomised, controlled trial. Lancet Neurol. 2015;14(9):893–902.
Souza WC, et al. Similar effects of two modified constraint-induced therapy protocols on motor impairment, motor function and quality of life in patients with chronic stroke. Neurol Int. 2015;7(1):5430.
Hosomi M, et al. A modified method for constraint-induced movement therapy: a supervised self-training protocol. J Stroke Cerebrovasc Dis. 2012;21(8):767–75.
Liu KPY, et al. A randomized controlled trial of self-regulated modified constraint-induced movement therapy in sub-acute stroke patients. Eur J Neurol. 2016;23(8):1351–60.
Lum PS, et al. Automated constraint-induced therapy extension (AutoCITE) for movement deficits after stroke. J Rehabil Res Dev. 2004;41(3A):249–58.
Lum PS, et al. A telerehabilitation approach to delivery of constraint-induced movement therapy. J Rehabil Res Dev. 2006;43(3):391.
Taub E, et al. AutoCITE: automated delivery of CI therapy with reduced effort by therapists. Stroke. 2005;36(6):1301–4.
Yoon JA, et al. Effect of constraint-induced movement therapy and mirror therapy for patients with subacute stroke. Ann Rehabil Med. 2014;38(4):458–66.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2024 The Author(s), under exclusive license to Springer Nature Switzerland AG
About this chapter
Cite this chapter
MacKenzie, H.M., Viana, R. (2024). Constraint-Induced Therapies. In: Ovbiagele, B., Kim, A.S. (eds) Ischemic Stroke Therapeutics. Springer, Cham. https://doi.org/10.1007/978-3-031-49963-0_24
Download citation
DOI: https://doi.org/10.1007/978-3-031-49963-0_24
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-031-49962-3
Online ISBN: 978-3-031-49963-0
eBook Packages: MedicineMedicine (R0)