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In constraint-induced movement therapy, stroke patients wear a sling on their good arm for approximately 90 percent of waking hours for fourteen straight days. On ten of those days, they receive six hours of therapy, using their seemingly useless arm: they eat lunch, throw a ball, play dominoes or cards or Chinese checkers, write, push a broom, and use standard rehab equipment called dexterity boards. “It is fairly contrary to what is typically done with stroke patients,” says Taub, “which is to do some rehabilitation with the affected arm and then, after three or four months, train the unaffected arm to do the work of both arms.” Instead, for an intense six hours daily, the patient works closely with therapists to master basic but crucial movements with the affected arm. Sitting across a pegboard from the rehab specialist, for instance, the patient grasps a peg and labors to put it into a hole. It is excruciating to watch, the patient struggling with an arm that seems deaf to the brain’s commands to extend far enough to pick up the peg; to hold it tightly enough to keep it from falling back; to retract toward the target hole; and to aim precisely enough to get the peg in. The therapist offers encouragement at every step, tailoring the task to make it more attainable if a patient is failing, then more challenging once the patient makes progress. The reward for inserting a peg is, of course, doing it again—and again and again. If the patient cannot perform a movement at first, the therapist literally takes him by the hand, guiding the arm to the peg, to the hole—and always offering verbal kudos and encouragement for the slightest achievement. Taub explicitly told the patients, all of whose strokes were a year or more in the past, that they had the capacity for much greater use of their arm than they thought. He moved it for them and told them over and over that they would soon do the same. In just two weeks of constraint-induced movement therapy with training of the affected arm, Taub reported in 1993, patients regained significant use of a limb they thought would forever hang uselessly at their side. The patients outperformed control patients on such motor tasks as donning a sweater, unscrewing a jar cap, and picking up a bean on a spoon and lifting it to the mouth. The number of daily-living activities they could carry out one month after the start of therapy soared 97 percent. That was encouraging enough. Even more tantalizing was that these were patients who had long passed the period when the conventional rehab wisdom held that maximal recovery takes place. That, in fact, was why Taub chose to work with chronic stroke patients in the first place. According to the textbooks, whatever function a patient has regained one year after stroke is all he ever will: his range of motion will not improve for the rest of his life.
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Jeffrey M. Schwartz (The Mind & The Brain: Neuroplasticity and the Power of Mental Force)