Constraint-Induced Movement Therapy: A new family of techniques with broadapplication to physical rehabilitation - A clinical review

A new family of rehabilitation techniques, termed Constraint-Induced Moveme nt Therapy or CI Therapy, has been developed that controlled experiments ha ve shown is effective in producing large improvements in limb use in the re al-world environment after cerebrovascular accident (CVA). The signature th erapy involves constraining movements of the less-affected arm with a sling for 90% of waking hours for 2 weeks, while intensively training use of the more-affected arm. The common therapeutic factor in all CI Therapy techniq ues would appear to be inducing concentrated, repetitive practice of use of the more-affected limb. A number of neuroimaging and transcranial magnetic stimulation studies have shown that the massed practice of CI Therapy prod uces a massive use-dependent cortical reorganization that increases the are a of cortex involved in the innervation of movement of the more-affected li mb. The CI Therapy approach has been used successfully to date for the uppe r limb of patients with chronic and subacute CVA and patients with chronic traumatic brain injury and for the lower limb of patients with CVA, incompl ete spinal cord injury, and fractured hip. The approach has recently been e xtended to focal hand dystonia of musicians and possibly phantom limb pain.