PHYS THER
Vol. 89, No. 6, June 2009, pp. 544-545
DOI: 10.2522/ptj.20080017.ar2
This Article
Right arrow Extract Freely available
Right arrow Full Text (PDF)
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when Rapid Responses are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Hammer, A. M.
Right arrow Articles by Lindmark, B.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Hammer, A. M.
Right arrow Articles by Lindmark, B.
Related Collections
Right arrow Adaptive/Assistive Devices
Right arrow Therapeutic Exercise
Right arrow Hemiplegia/Paraplegia/Quadriplegia
Right arrow Motor Control and Motor Learning
Right arrow Stroke (Neurology)
Right arrow Stroke (Geriatrics)
Social Bookmarking
Add to CiteULike   Add to Complore   Add to Connotea   Add to Del.icio.us   Add to Digg   Add to Reddit   Add to Technorati  
What's this?

Research Reports

Author Response

Ann M. Hammer and Birgitta Lindmark


We appreciate the commentary provided by Charles1 and will respond to the questions posed, as several of the points were congruent with our presentation.

The original forced-use studies administered nothing but a restraint.2,3 The broadened definition stated in the commentary by Charles was not applied in our study.4 Details in our article specify that forced use was applied with a restraint in connection with the ongoing rehabilitation in the departments concerned. The behavior contract is rather a component of the classic constraint-induced movement therapy (CIMT) paradigm,5 although it recently has received more emphasis.6 Goal setting and treatment planning are core duties in interdisciplinary rehabilitation programs and not exclusively in CIMT. Some reviews7,8 emphasized that data on efficacy or effectiveness of CIMT are limited and that conclusions remain uncertain.

The evaluation of sling use together with ongoing rehabilitation seemed appropriate at the start of our study. The intention of enhanced outcomes focused the general goal of motor rehabilitation—improved motor function and capacity and performance of daily activities, with a focus on the paretic arm. This goal historically has been present9–11 in training approaches preceding forced use and CIMT. Even though the critical elements of CIMT are inconclusively investigated, the really new component of the concept was, and is, the restraint. The protocol for CIMT6 points out the importance of a physical restraint as a reminder to limit the use of the unaffected limb. A sling or a mitt is evidently a more substantial marker than no physical restraint for facilitation of arm practice and use, probably having an influence not only on the patients, but also on therapists and others encountering the "forced" patient. The shorter situations of restraint removal in our study probably were because the patients could not manage the activity without the unaffected hand. Therefore, the suggestion of Charles was not probable, but rather these situations were not focused on enhanced use of the affected hand.

As noted in our article, the details of the training performed unfortunately were not tracked in our study. As Morris et al6 pointed out, however, there are many facets of motor interventions that make this recording very challenging: the chosen activity or task, levels of difficulty progression, duration and intensity, feedback manners, movements emphasized, and interaction between the therapist and the patient such as coaching, encouragement, and modeling.

The research of brain plasticity is exciting, promising, and important. Nevertheless, interventions need to be proven efficient for the patient's capacity and performance in daily motor functions and activities. In addition, interventions need to be feasible in clinical contexts, which is not assured in classic CIMT. Along with feasibility, interventions need to be relevant and adjusted on an individual basis to the poststroke condition of each patient in a clinical context.


arrow
References
 
  1. Charles J. Invited commentary on "Effects of forced use on arm function in the subacute phase after stroke: a randomized, clinical pilot study." Phys Ther. 2009;89:542–544.[Free Full Text]
  2. Ostendorf CG, Wolf SL. Effect of forced use of the upper extremity of a hemiplegic patient on changes in function. A single-case design. Phys Ther. 1981;61:1022–1028.[Abstract/Free Full Text]
  3. Wolf SL, Lecraw DE, Barton LA, et al. Forced use of hemiplegic upper extremities to reverse the effect of learned nonuse among chronic stroke and head-injured patients. Exp Neurol. 1989;104:125–132.[CrossRef][Web of Science][Medline]
  4. Hammer AM, Lindmark B. Effects of forced use on arm function in the subacute phase after stroke: a randomized, clinical pilot study. Phys Ther. 2009;89:526–539.[Abstract/Free Full Text]
  5. Morris DM, Crago JE, DeLuca SC, et al. Constraint-induced movement therapy for motor recovery after stroke. Neurorehabilitation. 1997;9:29–43.[CrossRef][Web of Science]
  6. Morris DM, Taub E, Mark VW. Constraint-induced movement therapy: characterizing the intervention protocol. Eura Medicophys. 2006;42:257–268.[Medline]
  7. Hakkennes S, Keating JL. Constraint-induced movement therapy following stroke: a systematic review of randomised controlled trials. Aust J Physiother. 2005;51:221–231.[Web of Science][Medline]
  8. Bonaiuti D, Rebasti L, Sioli P. The constraint induced movement therapy: a systematic review of randomised controlled trials on the adult stroke patients. Eura Medicophys. 2007;43:139–146.[Medline]
  9. Ernst E. A review of stroke rehabilitation and physiotherapy. Stroke. 1990;21:1081–1085.[Abstract/Free Full Text]
  10. Shumway-Cook A, Woollacott MH. Motor Control: Theory and Practical Applications. Baltimore, MD: Williams & Wilkins; 1995.
  11. Bobath B. Adult Hemiplegia: Evaluation and Treatment. 2nd rev ed. London: Heinemann; 1978.

Add to CiteULike CiteULike   Add to Complore Complore   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to Technorati Technorati    What's this?



This Article
Right arrow Extract Freely available
Right arrow Full Text (PDF)
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when Rapid Responses are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Hammer, A. M.
Right arrow Articles by Lindmark, B.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Hammer, A. M.
Right arrow Articles by Lindmark, B.
Related Collections
Right arrow Adaptive/Assistive Devices
Right arrow Therapeutic Exercise
Right arrow Hemiplegia/Paraplegia/Quadriplegia
Right arrow Motor Control and Motor Learning
Right arrow Stroke (Neurology)
Right arrow Stroke (Geriatrics)
Social Bookmarking
Add to CiteULike   Add to Complore   Add to Connotea   Add to Del.icio.us   Add to Digg   Add to Reddit   Add to Technorati  
What's this?