title: Forced use after TBI: promoting plasticity and function through practice.
abstract: OBJECTIVE
  To review the literature supporting, and determine the efficacy of, modified constraint-induced therapy (mCIT) in improving more affected upper limb use and function in patients with traumatic brain injury (TBI).
  
  
  METHODS
  Multiple-baseline, pre-post, case series.
  
  
  METHODS
  Outpatient clinic.
  
  
  METHODS
  Three patients with TBI occurring >1 year ago and exhibiting stable upper limb hemiparesis and learned non-use.
  
  
  METHODS
  Patients participated in 10 sessions of 30 minute, structured physical and occupational therapy, emphasizing more affected arm use in valued, functional activities, three times/week for 10 weeks and using shaping techniques. Their less affected upper limbs were also restrained 5 days/week during 5 hours identified as times of frequent use during the same 10-week period.
  
  
  METHODS
  The Action Research Arm Test (ARA), Wolf Motor Function Test (WMFT) and Motor Activity Log (MAL).
  
  
  RESULTS
  Following intervention, subjects exhibited improvements >2.0 in their amount and quality of more affected limb use, as measured by the MAL. Subjects 1, 2 and 3 also displayed functional improvements on the ARA (14.0, 5.5 and 6.0, respectively), improvements in ratings of WMFT task performance (1.15, 1.7 and 1.35, respectively) and diminished time needed to perform all WMFT tasks.
  
  
  CONCLUSIONS
  mCIT is a promising approach by which improved more affected limb use and function can be realized following TBI.
authors.affiliation: University of Cincinnati College of Medicine, Department of Physical Medicine and Rehabilitation, Cincinnati, OH 45267, USA. stephen.page@uc.edu
authors.forename: Stephen
authors.initials: S
authors.lastname: Page
authors.lastname: Levine Peter
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care; D001930:Brain Injuries / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009048:Motor Skills / Q000502:physiology; D009788:Occupational Therapy / Q000379:methods*; D026741:Physical Therapy Modalities / Q000379:methods*; D011446:Prospective Studies; D011596:Psychomotor Disorders / Q000534:rehabilitation; D012149:Restraint, Physical; D013647:Task Performance and Analysis; D016896:Treatment Outcome; D034941:Upper Extremity