Constraint-Induced Therapy

[MSKmonky]

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Has anyone here ever prescribed Constraint-induced therapy for unilateral weakness in post-CVA patients? what has been your experience with it? Did it work? I'm assuming Constraint-induced therapy is mostly done months after the acute injury (and perhaps continued for quite some time).

 

[PMR 4 MSK]

It's been a few years since I've done inpatient, but even outpt I've used it with some success. Studies on it mostly show benefits. We started experimenting with it when I was a resident (>11 years now). I think it is a great option to try in the acute and post-acute settings.

 

[ml2001]

There is a lot of discussion going on currently about this issue at my residency program. Studies have shown that it works really well. However, it is a very laborious therapy modality and therapists are excited, but don't think they have enough time to do it. It might be awesome to do in an outpt setting.

 

[RUOkie]

yes and yes with a *

I have gotten slings for the non affected side. And I almost universally want NDT type forced use. But, no payer is going to pay for 4hrs of one on one PT/OT 5 d/wk. (which is what the studies used in proving benefit).

 

[PMR 4 MSK]

yes and yes with a *

I have gotten slings for the non affected side. And I almost universally want NDT type forced use. But, no payer is going to pay for 4hrs of one on one PT/OT 5 d/wk. (which is what the studies used in proving benefit).

You don't have to do 1-on-1 PT/OT for it. Send them back up to the rehab floor or home with the good arm constrained. Have nursing and/or family trained to assist and reinforce.

Pt has to be cognizant of it, so it's more difficult with left-neglect. Pt has to be motivated to do it.

 

[RUOkie]

You don't have to do 1-on-1 PT/OT for it. Send them back up to the rehab floor or home with the good arm constrained. Have nursing and/or family trained to assist and reinforce.

Pt has to be cognizant of it, so it's more difficult with left-neglect. Pt has to be motivated to do it.

that was exactly my point, and what I do.

But if you read the studies that showed benefit they clearly state that the patients were treated 1:1 with OT for "forced use" for 4hrs/d --5d/wk

They also exclude all patients with spasticity, L neglect, poor balance, etc. This stuff has never been tested in the real world because the differences are so small, and the real world population is so heterogeneous.

Hence, we extrapolate our clinical treatment from research that is not available in clinical practice.