Hard Work Pays Off

Stroke Expert Says Intense Therapy Can Help Stroke Patients Regain Function in Their Arms

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by Dr. Edward Taub

Special to ABCNEWS.com
Feb. 22 — While a great deal of attention has been paid to early stroke treatment and injury prevention, brain damage, unfortunately, still occurs.

And for the many people who are left with impaired use of their arms or legs, the next important question is to ask what we can do to help these individuals regain the use of their limbs and improve their quality of life.

For years, the common belief in the field of stroke rehabilitation has been that traditional physical therapy methods have little beneficial effect for patients after their motor ability has reached a plateau following stroke. The degree of movement a patient has six months or a year after stroke is as good as it is ever going to be.

However, in recent years new data has shown that treating patients with an intense, two-week regimen called Constraint-Induced Movement therapy, or CI therapy, can produce substantial improvement, allowing patients to regain a great deal of the lost ability to move an arm or leg, even many years after the stroke occurred.

Facilitating Brain Re-Wiring

CI therapy takes advantage of and enhances the brain’s ability to heal itself and restore function to damaged areas.

When a person’s brain is damaged by a stroke, it often becomes more difficult for them to move an arm. The person therefore tends to use the arm less. This leads to shrinkage of the regions of the brain that control arm movement which in turn makes movement of the arm even more difficult. That in turn results in a vicious spiral downward during which the person uses the arm less and less.

CI therapy is the cavalry charge that can restore function by expanding the arm motor area of the brain, allowing the area to regain a substantial portion of its original function. This process is called cortical reorganization.

During CI therapy, patients spend two weeks as day-patients in the hospital clinic where they perform intensive physical therapy training with their affected arms for six hours a day, forcing renewed stimulation to the previously unused areas of the brain.

Each patient’s good, or unaffected, hand is constrained in a large mitt to prevent its use. As a result, massive cortical reorganization begins to take place as the brain once again receives signals from the affected arm, triggering new connections.

Conventional therapy is given for one-half to one hour a day one to three times a week for a period of several weeks or a few months, but rarely for more than 24 total hours of treatment. The intensive, extended nature of CI therapy, or what is called “massed practice,” is what makes CI so therapeutic.

The results of CI therapy have been striking. After two weeks of therapy, patients begin using their affected arms to dress themselves, write checks, sign their names, brush their teeth, comb their hair or perform any of the myriad tasks of daily living.

It should be pointed out, however, that CI must still be considered experimental until controlled clinical trials have proven the therapy effective in large groups of patients. These trials are currently underway in the United States, and many stroke experts are confident that the results will confirm CI’s therapeutic effects.

Overcoming Psychological Obstacles

In addition to physical strengthening, patients must also receive a great deal of encouragement to instill the belief that mobility can be regained.

In the immediate aftermath of a stroke, the severe trauma suffered by the brain often blocks a patient’s ability to move his or her arm and leg on one side of the body. As time passes, the trauma lessens, releasing the block.

During this period of reduced mobility, however, the patient “learns” not to attempt to use the affected arm or leg, because it does not work. Efforts to make it work are painful, or futile, and perhaps even embarrassing. The patient also hears negative messages from many health professionals who believe that continued therapy would not produce a beneficial change. We call this “learned non-use”.

Fortunately, studies conducted at the University of Alabama at Birmingham and the Birmingham Veterans Affairs Medical Center have shown that learned non-use can be overcome and reversed.

We have found that this combination of intense training of the weak side with restraint of the stronger side can help stroke sufferers significantly increase the use of their arms and legs, and lead more mobile, fuller lives.

Edward Taub, PhD, is a Professor of Psychology at the University of Alabama at Birmingham and an investigator at the Birmingham Veterans Affairs Medical Center. For more information, call The University of Alabama at Birmingham Taub Training Clinic at (205) 975-9799.

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