Constraint-Induced Movement Therapy for Stroke Rehabilitation
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Constraint-Induced Movement Therapy for Stroke Rehabilitation I. Saturday Workshop Outline A. Introduction 1. Who were the originators of CIMT? 2. What is CIMT? 3. Why was this therapy developed? 4. When was CIMT started? 5. Where did CIMT originate? B. History of CIMT 1. Studies on Motor Programming 2. Animal deafferentation experiments: Does sensory drive motor? 3. Learned Nonuse 4. Learned Helplessness as applies to movement control 5. The pairing of investigators Taub and Wolf 6. Bias 7. EXCITE Trial: NIH Phase III Clinical Trial 8. Controversies: VanderLee’s work (Questions and Answers) C. Evaluating the Outcomes of CIMT: The standard tests for CIMT. 1. Capacity or Best Possible Performance: Wolf Motor Function Test (WMFT) Mini Lab on the WMFT: Video Demonstration 2. Spontaneous or Self-Selective Activity: Actual Amount of Use Test (AAUT) Mini Lab on the AAUT: Video Demonstration 3. Self Motivated Activities Attempted and Perceptions of Activities Performed. Testing the Client and the Caregiver: Motor Activity Log (MAL) Mini Lab on the MAL: Video Demonstration (Questions and Answers) D. Other Tests Used that are not specific to CIMT 1. Box and Block 2. Stroke Impact Scale 3. Fugl Meyer Stroke Recovery Test 4. Frenchay IADL 5. Sensory, proprioception, stereognosis testing 6. Goals graded on Likert Scale E. Laboratory Training and Review of Testing II. Sunday Workshop Outline A. What are the criteria for acceptance into this therapeutic intervention? To whom does this treatment apply? B. Video Demonstration of Treatment C. CIMT Intervention: The Specifics 1. Rules for the constraint device. How much do I wear the mitt? 2. Shaping by successive approximation 3. Massed Practice 4. What types of activities? The activity menus. 5. Developing the specific plan D. Populations Other than Stroke: Pediatrics, Brain Injury, etc. E. Laboratory on Treatment F. Current Research 1. Low Functioning versus high functioning clients 2. Using EMG Biofeedback and Functional Electrical Stimulation as an adjunct to treatment 3. Will a home-based training program work? 4. Can we modify the training and get the same results? G. Adherence Instruments: Necessity of Intensive Massed Practice. 1. The activity log 2. Keeping the home diary 3. Writing the contract for adherence to the plan 4. The compliance device in the mitt H. Laboratory on Treatment: Developing a plan and using the adherence instruments I. Are we ready to use this treatment? J. Questions and Answers: Closing Discussion.