Behavioral Training and Oven Mitts Become a Recipe for Recovery

Research on how animals respond to injuries leads to an effective new therapy for stroke victims.

In the late 1950s, Edward Taub and colleagues began a program of research on how animals respond to brain or spinal cord injuries. They already knew that when monkeys lose the ability to feel a limb because of nerve damage, they stop using the limb, permanently. Research showed that this loss of movement occurred even when there was no damage to the motor nerves that controlled an affected limb. However, Taub's research team discovered that if they prevented monkeys from using the remaining, healthy limb, the monkeys did learn to use the affected limb.

Later, Taub's team added a second component to this treatment. Specifically, they not only constrained the healthy arm but also applied basic conditioning procedures to the affected arm (by rewarding anything that resembled a desired behavior and then becoming increasingly strict about what was rewarded). This novel procedure became known as Constraint-Induced Movement therapy or CI therapy, and research with animals showed that it was a very effective treatment for spinal cord injuries that otherwise led to the equivalent of permanent paralysis.

If the blood supply to a specific region of the brain is seriously disrupted, the resulting damage is referred to as a stroke. Stroke not only kills about 80,000 Americans per year but also takes its toll on those who survive it. Most stroke victims experience a loss of motor functioning. This loss might be as minor as a reduced ability to use the fingers in one hand or as major as weakness or paralysis in an entire half of the body. Until very recently, the outlook for physical rehabilitation for patients who had experienced a stroke more than 6 months to 1 year earlier was grim. As a result, rehabilitation efforts were rarely carried out with such patients. They were told that there was no longer anything that could be done to improve their movement. In short, these patients had no hope of recovery. Today, however, patients with stroke are experiencing gains that would have been thought impossible 10 or 20 years ago. The secret to this medical breakthrough is not surgical advances, gene therapy, or miracle drugs. Instead it is a behavioral treatment that was put to work based on the groundbreaking work of Taub and associates.

By applying their animal rehabilitation research, Taub and colleagues developed a new therapy for stroke victims. The therapy restrains the patient's good, unaffected hand in a mitt for most waking hours every day for two weeks. Patients are then guided for many hours each weekday through a series of motor activities that they must perform with the affected hand (e.g., picking up and stacking blocks or writing their names). In patients with mild to moderately severe loss of movement of one hand, virtually every patient who has received this treatment to date has shown meaningful improvements. A clinic providing this therapy to patients opened in October of 2001 at the University of Alabama at Birmingham Medical Center. Since that date, the therapy has spread to numerous clinics and research sites all over the U.S. and Europe. At the time of this writing (October, 2003), several thousand patients had already benefited from this new form of therapy, and its use was spreading rapidly.

Taub, E., Uswatte G., & Pidikiti, R. (1999). Constraint-Induced Movement therapy: A new family of techniques with broad application to physical rehabilitation--a clinical review. Journal of Rehabilitation Research and Development, Vol. 36, pp. 237-51.

Taub, E., Crago, J.E., & Uswatte, G. (1998). Constraint-Induced Movement therapy: A new approach to treatment in physical rehabilitation. Rehabilitation Psychology, Vol. 2, pp. 152-170.

---

American Psychological Association, November 10, 2003