Constraint-InducedMovementTherapyanditsApplicationto强制性运动疗法及其应用.pptVIP

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Constraint-InducedMovementTherapyanditsApplicationto强制性运动疗法及其应用.ppt

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Constraint-InducedMovementTherapyanditsApplicationto强制性运动疗法及其应用

Constraint-Induced Movement Therapy and its Application to Physical and Occupational Therapy Nicole M. Boyko, PT/s Background Information 730,000 strokes/yr 50% patients have motor deficits 30-66% of patients are unable to use affected UE for ADLS following stroke What is Constraint-Induced Movement Therapy? A technique in which the patient uses concentrated, repeated practice of the affected extremity in order to facilitate movement Shaping: a behavioral technique in which quality of movement is improved progressively in small steps Family of techniques includes: Restraining of less affected UE in hand splint and/or sling while subsequently shaping the hemiplegic UE Wearing glove/mitt on less affected hand while shaping hemiplegic hand Shaping of hemiplegic UE or LE without restraint of unaffected side Intense PT of hemiplegic side 5 hrs/day x 10 week days without restraint of unaffected side (pts asked not to use unaffected side) Rationale “Learned nonuse”: a conditioned suppression of mvmt that occurs when pt is initially unsuccessful at using affected extremity immediately post-injury and is reinforced by successful compensation with unaffected extremity. Shortened rehab LOS forces therapists to focus on teaching compensatory techniques in order to maximize fxn for safe return to home Areas of the cortex controlling movements of the affected limb shrink following stroke due to a combination of direct insult and learned nonuse Preliminary studies show that repeated forced use of impaired limb results in improved mvmt and enlargement of these areas. Current Research EXCITE (Extremity Constraint Induced Therapy Evaluation) 5 yr NIH supported trial Sites: U of Alabama at Birmingham, Emory U, UNC/Wake Forest School of Medicine, UCLA, UFL at Gainesville, Ohio State Protocol: less affected UE restrained in sling for 90% of waking hours x 2 wks; training of most affected UE 6 hrs/day with 1 hr rest x 10 weekdays Diagnoses for which CI is being researched: CVA (UE a