ConstraintInducedMovementTherapyanditsApplicationto强制性运动疗法及其应用课件

1、Constraint-Induced Movement Therapy and its Application to Physical and Occupational TherapyNicole M. Boyko, PT/s第1页，共15页。Background Information730,000 strokes/yr50% patients have motor deficits30-66% of patients are unable to use affected UE for ADLS following stroke第2页，共15页。What is Constraint-Indu

2、ced Movement Therapy?A technique in which the patient uses concentrated, repeated practice of the affected extremity in order to facilitate movementShaping: a behavioral technique in which quality of movement is improved progressively in small stepsFamily of techniques includes:Restraining of less a

3、ffected UE in hand splint and/or sling while subsequently shaping the hemiplegic UEWearing glove/mitt on less affected hand while shaping hemiplegic handShaping of hemiplegic UE or LE without restraint of unaffected sideIntense PT of hemiplegic side 5 hrs/day x 10 week days without restraint of unaf

4、fected side (pts asked not to use unaffected side)第3页，共15页。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 r

5、ehab LOS forces therapists to focus on teaching compensatory techniques in order to maximize fxn for safe return to homeAreas of the cortex controlling movements of the affected limb shrink following stroke due to a combination of direct insult and learned nonusePreliminary studies show that repeate

6、d forced use of impaired limb results in improved mvmt and enlargement of these areas.第4页，共15页。Current ResearchEXCITE (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, O

7、hio StateProtocol: 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 weekdaysDiagnoses for which CI is being researched: CVA (UE and LE), SCI (LE only), hip fx/replacement, focal hand dystonia in musicians, cerebral palsy

8、 in children第5页，共15页。Availability of CIMTTaub training clinic opened at UAB in Aug 2001Provides 2-3 wks CIMT for UE primarily for patients post strokeMedicare does not coverPrivate pay: 2 wks: $6700, 3 wks: $12, 700CI therapy research labs offer CIMT for strokes, SCI, hip Fx, CP and hand dystonia fo

9、r free to qualifying pts at select locations第6页，共15页。Literature ReviewSubjects/Methods61 y/o African-American female 4 mo s/p ischemic lacunar infarct of (L) post limb of internal capsuleFxnl status: (I) ADLs, amb device, no voluntary use of (R) UEReceived CIMT using mitt on (L) UE for 90% waking hr

10、s x 14 daysPractice performing ADLS with (R) UE in clinic 6 hrs/day x 10 days with 1-2 hrs/day restBlanton and Wolf (1999)第7页，共15页。Literature ReviewMeasures Taken before, after, 3 mo f/uWolf Motor Function Test (14 timed, 2 strength)Motor Activity Log (30 ADLS)ResultsImproved on all items on WMFTPri

11、or to Rx, using (R) UE for 1/30 tasks on MALAfter Rx, using (R) UE 50% as much on 25/30Upon 3 mo f/u, using (R) UE for 30/30 tasksBlanton and Wolf (1999)第8页，共15页。Literature ReviewSubjects/Methods4 patients in CIMT grp, 5 in placebo groupInclusion criteria: 20 wrist ext, 10 finger extExp grp:CIMT wit

12、h unaffected UE in resting hand splint for 90% of waking hrs x 14 daysSling also used during 6 hrs/day of Rx x 10 days in performing activities such as eating, throwing a ball, playing board games, writing, sweepingPlacebo: told they had greater capacity to use affected UE and instructed in passive

13、exTaub et al (1999)第9页，共15页。Literature ReviewMeasures: WMFT, MAL, Arm Motor Ability TestResultsExperimental grp showed significant increases on WMFT and AMAT while controls showed no change or a declineExperimental grp showed a very large significant increase in real-world affected extremity use as

14、measured by MAL which persisted at 2 yr f/u. Controls showed no change or a decline.Taub et al. (1999)第10页，共15页。Literature ReviewPurpose: to use CIMT as a model to assess therapy-induced plasticity in stroke patientsSubjects/Methods10 men and 3 women with chronic hemiplegia post strokeInclusion crit

15、eria same as previous Taub studyCIMT with unaffected UE in resting hand splint for 90% waking hrs x 12 daysSling also applied to unaffected UE in clinic for 6 hrs/day of Rx for 8 days to increase quality of mvmt and use of affected UELiepert et al. (2000)第11页，共15页。Literature ReviewMeasures: MAL, tra

16、nscranial magnetic stimulation mapping of motor output, motor threshold, and amplitude weighted center of activation sites (CoG)Results1 day post Rx, 37.5% more activity in affected hemisphere was notedIncreased cortical representation area in affected hemisphereIncrease in ADLs persisting at 6 mo f

17、/uLiepert et al. (2000)第12页，共15页。ConclusionsCIMT has been proven effective in subacute and chronic stroke for all but the 25% of pts with most severely impaired extremity fxnCIMT may reverse the “learned nonuse” behavior by making pts more willing to use the affected extremity in functional ADLsCIMT seems to result in cortical reorganization which represents the pts actual potential for recovery of fxn in the affected extremities第13页，共15页。Questions for Acute Care Practitioners to PonderCan compensatory skil