Dear Doctors column

August 2008  

Retraining the Brain After Stroke  

Question:

I heard a news report about a UAB rehabilitation program that helps restore hand, arm, and leg movement in patients who have lost function after a stroke. What can you tell me about this therapy?  

Answer:

Constraint-Induced Movement Therapy (CIMT) is a rehabilitation technique created by UAB behavioral neuroscientist Edward Taub, PhD. UAB’s Taub Therapy Clinic offers CIMT to patients who have lost motor function in a limb due to a stroke, traumatic brain injury (TBI), or brain surgery.

Programs at UAB’s Taub Training Clinic involve therapy that focuses on retraining the brain to stop relying primarily on the unaffected limb and once again perform tasks with the affected arm, hand, or leg. Practicing exercises with the affected limb while restraining the normally functioning limb causes the brain to rewire itself and relearn motor skills lost to neurologic injury. CIMT is most effective when begun at least 6 months after a stroke or TBI and in people who have already completed traditional rehabilitation.

Between 55% and 75% of stroke survivors have lingering disabilities that limit their ability to perform daily activities. Until recently it was believed that stroke patients could regain lost function only within a certain period (from the time of stroke to 6 months afterwards) and that any remaining disability after that time was unlikely to improve.

Yet recent studies of CIMT show that patients can make significant gains in movement, strength, and coordination months and even years after the original injury. In about a third of stroke cases, someone, typically a spouse, must quit their job to care for the patient full time. Research has found that about 70% of those caregivers can return to work once their loved one completes CIMT.

People who are interested in taking part in CIMT need to be able to travel to the Taub Therapy Clinic in Birmingham, Alabama, where they will work with physical and occupational therapists for 2 to 3 weeks. During daily session that last 3 or 7 hours (the length depends on the severity of the symptoms), therapists guide and encourage patients through a series of tasks with the affected limb.

For injuries to the upper extremity, patients wear a special restraining mitt on their unaffected hand, which encourages them use their injured limb. Typical exercises include picking up or stacking small objects and practicing other tasks that mimic the activities of daily living.

A restraining device is not used for lower extremity injuries. Therapists encourage patients to rely on their affected leg to perform repetitive exercises such as rising from a chair,  climbing stairs, or walking on a treadmill. After completing therapy at the clinic, therapists design an individualized at-home program that helps patients maintain and continue improvements. 

CIMT involves no medication or surgery, but is designed to be challenging and demands a high level of commitment from patients. The Taub Therapy Clinic notes that the keys to success with CIMT include:

Ø      A commitment to improve arm or leg function.

Ø      A determination to succeed.

Ø      A willingness to focus and follow instructions.

Ø      The motivation to work hard to achieve goals.

CIMT is designed for individuals who retain at least limited movement in the affected limb. Interested patients must undergo physical evaluation at the Taub Clinic so experts can decide whether their disability will respond to therapy. CIMT pioneer Dr. Edward Taub, who personally oversees treatment programs at the clinic, notes that the great majority of stroke patients who have completed CIMT experienced substantial, significant, clinically meaningful improvements.

Visit the Taub Therapy Clinic’s Web site to learn more about CIMT, available programs, and costs.