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1、Constraint-InducedMovementTherapyanditsApplicationtoPhysicalandOccupationalTherapyNicoleM.Boyko,PT/sBackgroundInformation730,000strokes/yr50%patientshavemotordeficits30-66%ofpatientsareunabletouseaffectedUEforADLSfollowingstrokeWhatisConstraint-InducedMovementTherapy?Atechn
2、iqueinwhichthepatientusesconcentrated,repeatedpracticeoftheaffectedextremityinordertofacilitatemovementShaping:abehavioraltechniqueinwhichqualityofmovementisimprovedprogressivelyinsmallstepsFamilyoftechniquesincludes:RestrainingoflessaffectedUEinhandsplintand/orslingwhilesu
3、bsequentlyshapingthehemiplegicUEWearingglove/mittonlessaffectedhandwhileshapinghemiplegichandShapingofhemiplegicUEorLEwithoutrestraintofunaffectedsideIntensePTofhemiplegicside5hrs/dayx10weekdayswithoutrestraintofunaffectedside(ptsaskednottouseunaffectedside)Rationale“Learne
4、dnonuse”:aconditionedsuppressionofmvmtthatoccurswhenptisinitiallyunsuccessfulatusingaffectedextremityimmediatelypost-injuryandisreinforcedbysuccessfulcompensationwithunaffectedextremity.ShortenedrehabLOSforcestherapiststofocusonteachingcompensatorytechniquesinordertomaximiz
5、efxnforsafereturntohomeAreasofthecortexcontrollingmovementsoftheaffectedlimbshrinkfollowingstrokeduetoacombinationofdirectinsultandlearnednonusePreliminarystudiesshowthatrepeatedforceduseofimpairedlimbresultsinimprovedmvmtandenlargementoftheseareas.CurrentResearchEXCITE(Ext
6、remityConstraintInducedTherapyEvaluation)5yrNIHsupportedtrialSites:UofAlabamaatBirmingham,EmoryU,UNC/WakeForestSchoolofMedicine,UCLA,UFLatGainesville,OhioStateProtocol:lessaffectedUErestrainedinslingfor90%ofwakinghoursx2wks;trainingofmostaffectedUE6hrs/daywith1hrrestx10week
7、daysDiagnosesforwhichCIisbeingresearched:CVA(UEandLE),SCI(LEonly),hipfx/replacement,focalhanddystoniainmusicians,cerebralpalsyinchildrenAvailabilityofCIMTTaubtrainingclinicopenedatUABinAug2001Provides2-3wksCIMTforUEprimarilyforpatientspoststrokeMedicaredoesnotcoverPrivatepa
8、y:2wks:$6700,3wks:$12,700CItherapyresearchlabsofferCIMTforstrokes,SCI,hipFx,CPandh
