Forced use after TBI: promoting plasticity and function through practice.
OBJECTIVE: To review the literature supporting, and determine the efficacy of, modified constraint-induced therapy (mCIT) in improving more affected upper limb use and function in patients with traumatic brain injury (TBI). DESIGN: Multiple-baseline, pre-post, case series. SETTING: Outpatient clinic. PATIENTS: Three patients with TBI occurring >1 year ago and exhibiting stable upper limb hemiparesis and learned non-use. INTERVENTION: Patients participated in 10 sessions of 30 minute, structured physical and occupational therapy, emphasizing more affected arm use in valued, functional activities, three times/week for 10 weeks and using shaping techniques. Their less affected upper limbs were also restrained 5 days/week during 5 hours identified as times of frequent use during the same 10-week period. MAIN OUTCOME MEASURES: The Action Research Arm Test (ARA), Wolf Motor Function Test (WMFT) and Motor Activity Log (MAL). RESULTS: Following intervention, subjects exhibited improvements >2.0 in their amount and quality of more affected limb use, as measured by the MAL. Subjects 1, 2 and 3 also displayed functional improvements on the ARA (14.0, 5.5 and 6.0, respectively), improvements in ratings of WMFT task performance (1.15, 1.7 and 1.35, respectively) and diminished time needed to perform all WMFT tasks. CONCLUSIONS: mCIT is a promising approach by which improved more affected limb use and function can be realized following TBI.