Family and Friends - Constraint Therapies

HISTORY
 
Inconsistencies in the definition of constraint therapy used with children with cerebral palsy has led to interventions being listed in the literature as restraint-therapy, constraint-induced therapy, constraint-induced movement therapy, modified constraint-induced movement therapy, and forced-use treatment. Although these different labels do not necessarily refer to the exact same interventions, they are rooted in research where restraint therapies were shown to be effective in diminishing hemiplegic symptoms in monkeys and later in stroke patients. Success in the latter subjects led to speculation that the same therapies could be applicable to hemiplegic children with cerebral palsy.
 
Experiments in which the sensory nerves of one of the arms of monkeys were removed or interrupted (deafferentation) caused the monkeys to neglect the use their affected limbs. Instead, the monkeys would rely solely on the opposite, fully-functional limb. The neglect, or learned non-use, of the affected limbs however, was found to be reversible. Reactivation of a neglected arm was possible if the other, functional limb was restrained and intensive, repetitive practice (shaping) was undertaken using the unrestrained arm.
 
In the early 1980s scientists drew parallels between the deafferentated monkeys of the above mentioned experiments and adults who were suffering from hemiplegia due to stroke or traumatic head injuries. Pilot experiments were done that showed promising rehabilitation results in the stroke patients which in turn necessitated larger random controlled experiments. These larger studies supported the earlier evidence and thus advocated the use of constraint therapy. Even more exhaustive experiments are being undertaken to ensure the therapy’s effectiveness.