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Stroke is the leading cause of long-term disability [1]; therefore, identifying those individuals who can recover from directed rehabilitation techniques is essential. Constraint-induced movement therapy (CIMT) is a rehabilitative strategy used primarily with the post-stroke population. This therapy increases the functional use of the neurologically weaker upper extremity (UE) through massed practice while restraining the lesser involved UE [2]. The signature form of CIMT includes 10 days of training at 6 h per day [3,4]. CIMT is reported to significantly improve functional use of the UE in 20-25% of people with chronic stroke disability [5]. Limited evidence exists, however, regarding the specific characteristics of individuals who can best benefit from this intervention [6-10]. Most of the research has been conducted with heterogeneous samples, possibly masking the effect of the intervention for certain subgroups.
This review briefly presents the history of CIMT, including the animal studies upon which its basis was founded and then transitions to suggestions for future CIMT research. The focus of this review is on brain plasticity, but it also addresses the theoretical underpinnings of CIMT as extracted from the psychology literature. Emphasis is placed on the importance of type and location of the stroke and how this factor might influence responses to CIMT.
The goal of CIMT is to improve function in the more-affected UE [11]. The results of CIMT studies have demonstrated significant and lasting improvements of UE movement function [4,5,12-17]. Collectively, these data have shown that CIMT improves function in individuals post-stroke with varying levels of impairment. Patients with less function prior to CIMT tend to demonstrate less improvements with traditional CIMT than patients with higher levels of motor ability [7,18]. CIMT results have been labeled the most promising evidence that motor recovery can occur in the post-stroke hand in patients who have some residual, purposeful movement [19]. Despite promising evidence for the efficacy of CIMT, we are just starting to understand who will benefit from this form of therapy. For example, we know that very early after a stroke, a high intensity form of CIMT may be too much [20], thus a subacute [16] or chronic [12] application may be more appropriate. In addition, while active wrist extension is a predictor of improved motor performance following CIMT [7],...