How many neurons are lost during a stroke?
“Time Is Brain—Quantified” Jeffery L. Saver, MD. Stroke. 2006
Meditation helps the brain
Ekman, P., et al. (2005). Buddhist and psychological perspectives on emotions and well -Being. Current Directions in Psychological Science, 14, 59-63
The EXCITE trial: Large multi-site constraint induced therapy trial
Wolf SL, Winstein CJ, Miller JP, Taub E, Uswatte G, Morris D, Giuliani C, Light KE, Nichols-Larsen D; EXCITE Investigators. Effect of constraint-induced movement therapy on upper extremity function 3 to 9 months after stroke: the EXCITE randomized clinical trial. JAMA. 2006 Nov 1;296(17):2095-104. PubMed PMID: 17077374.
Constraint induced of the upper extremity helps lower extremity, balance, gait.
Fuzaro AC, Guerreiro CT, Galetti FC, Jucá RB, Araujo JE. Modified constraint-induced movement therapy and modified forced-use therapy for stroke patients are both effective to promote balance and gait improvements. Rev Bras Fisioter. 2012 Apr;16(2):157-65. Epub 2012 Mar 1. PubMed PMID: 22378476.
Lower extremity mCIT
Numata K, Murayama T, Takasugi J, Oga M. Effect of modified constraint-induced movement therapy on lower extremity hemiplegia due to a higher-motor area lesion. Brain Inj. 2008 Oct;22(11):898-904.
Spasticity declines during sleep, most of the time:
ES Tauber, RM Coleman, ED Weitzman. Absence of tonic electromyographic activity during sleep in normal and spastic nonmimetic skeletal muscles in man - Ann Neurol, 1977
Bilateral training drives cortical change
Cauraugh JH, Summers JJ. Neural plasticity and bilateral movements: A rehabilitation approach for chronic stroke. Prog Neurobiol. 2005 Apr;75(5):309-20. Review.
Meta-analysis indicates that bilateral movements are effective stroke rehabilitation protocols
Stewart KC, Cauraugh JH, Summers JJ. Bilateral movement training and stroke rehabilitation: a systematic review and meta-analysis. J Neurol Sci. 2006 May 15;244(1-2):89-95. Epub 2006 Feb 14. Review.
Kenisiotaping: Little proven efficacy
Mostafavifar M, Wertz J, Borchers J. A systematic review of the effectiveness of kinesio taping for musculoskeletal injury. Phys Sportsmed. 2012 Nov;40(4):33-40.
CIT with lower level patients
1. Application of CIMT for an Individual With Severe Chronic UE Hemiplegia. Bonifer. PT Vol. 83April 2003.
2. The ability to lift a wash rag off a tabletop using any type of prehension they could manage, and then release the rag (Taub E, et al. Constraint-Induced Movement Therapy: a new family of techniques with broad application to physical rehabilitation--a clinical review. J Rehabil Res Dev. 1999 Jul;36(3):237-51. )
3. (Bonifer N, Anderson KM. Application of constraint-induced movement therapy for an individual with severe chronic upper extremity hemiplegia. Phys Ther 2003; 83(4):384-98.)
4. Individuals who could barely lift a washrag off a tabletop. Page & Levine, 2007; Phys Ther.
Botox can be used to qualify survivors for CIT
Botulinum toxin a, evidence-based exercise therapy, and constraint-induced movement therapy for upper-limb hemiparesis attributable to stroke: a preliminary study. Levy CE, Giuffrida C, Richards L, Wu S, Davis S, Nadeau SE.. Am J Phys Med Rehabil. 2007 Sep;86(9):696-706.
CIT during the acute phase
Dromerick AW, Lang CE, Birkenmeier R, et al. Very Early Constraint-Induced Movement during Stroke Rehabilitation (VECTORS): a single-center RCT. Neurology. 2009;73:195–201. 17
1. Page, S.J., Levine, P., Sisto, S.A., Bond, Q., Johnston, M.V. Patients’ and therapists’ opinions of constraint-induced therapy. Clin Rehabil 2002; 16 (1): 55-60
2. Page SJ, Boe S, Levine P. What are the "ingredients" of modified constraint-induced therapy? An evidence-based review, recipe, and recommendations. Restor Neurol Neurosci. 2013 Feb 8.
3. Langan J, van Donkelaar P. The influence of hand dominance on the response to a constraint-induced therapy program following stroke. Neurorehabil Neural Repair.
4. Lynne V. Gauthier, MA; Edward Taub, PhD; Victor W. Mark, MD; Christi Perkins, BS Gitendra Uswatte, PhD. Improvement After CIMT Independent of Infarct Location in Chronic Stroke Patients. Stroke, 2009;40:2468-2472
5. Sterr A, Freivogel S. Intensive training in chronic upper limb hemiparesis does not increase spasticity or synergies. Neurology. 2004 Dec 14;63(11):2176-7.
6. Reductions in spasticity after CIT 2-week and at 6-month follow-up.
6. Reductions in spasticity after CIT 2-week and at 6-month follow-up.
7. CIT caused significant decreases in spasticity. (http://www.ncbi.nlm.nih.gov/pubmed /15706544)
1. Page, SJ. Hermann, V. Levine, P Retention of Motor Changes in Chronic Stroke Survivors Who Were Administered Mental Practice. Poster to be presented at the annual meeting of the American Congress of Rehabilitation Medicine/American Society of Neurorehabilitation, Atlanta, October, 2012
2. Page SJ, Murray C, Hermann V, Levine P. Retention of motor changes in chronic stroke survivors who were administered mental practice. Arch Phys Med Rehabil 2011; 92: 1711.
3. Page SJ, Dunning K, Hermann V, Leonard A, Levine P. Longer versus shorter mental practice sessions for affected upper extremity movement after stroke: a randomized controlled trial. Clin Rehabil. 2011 Mar 22.
1. Louise Anne Connell, BSc. PhD Thesis (Applied Psychology) University of Nottingham. Article is Free online; Please see appendix
2. Lynch EA, Hillier SL, Stiller K, Campanella RR, Fisher PH. Sensory retraining of the lower limb after acute stroke: a randomized controlled pilot trial. Arch Phys Med Rehabil. 2007 Sep;88(9):1101-7. Article is Free online; Please see appendix
3. Smania N, Montagnana B, Faccioli S, Fiaschi A, Aglioti SM. Rehabilitation of somatic sensation and related deficit of motor control in patients with pure sensory stroke. Arch Phys Med Rehabil. 2003 Nov;84(11):1692-702. PubMed PMID: 14639572.
Bilateral Arm Training With Rhythmic Auditory Cueing
1. Bilateral Arm Training With Rhythmic Auditory Cueing in Chronic Stroke: Not Always Efficacious, Richards, et al. Neurorehabilitation and Neural Repair
2. Stewart KC, Cauraugh JH, Summers JJ. Bilateral movement training and stroke rehabilitation: a systematic review and meta-analysis. J Neurol Sci. 2006 May 15;244(1-2):89-95. Epub 2006 Feb 14. Review.
3. Lin KC, Chang YF, Wu CY, Chen YA. Effects of constraint-induced therapy versus bilateral arm training on motor performance, daily functions, and quality of life in stroke survivors. Neurorehabil Neural Repair. 2009 Jun;23(5):441-8.
Speed-Dependent Treadmill Training
1. Speed-Dependent Treadmill Training (STT) in Ambulatory Hemiparetic Stroke Patients. Marcus Pohl, MD; Jan Mehrholz, PT; Claudia Ritschel, PT
2. Tyrell CM, Roos MA, Rudolph KS, Reisman DS. Influence of systematic increases in treadmill walking speed on gait kinematics after stroke. Phys Ther. 2011 Mar;91(3):392-403. doi: 10.2522/ptj.20090425. Epub 2011 Jan 20.
1. fMRI finding of cortical activation by neuromuscular electrical stimulation on wrist extensor muscles. Han BS, et al. Am J Phys Med Rehabil 2003;82:17–20.
2. Blickenstorfer, A., et al., Cortical and subcortical correlates of functional electrical stimulation of wrist extensor and flexor muscles revealed by fMRI. Hum Brain Mapp, 2008.
3. Smith, G.V., et al., Functional MRI determination of a dose-response relationship to lower extremity neuromuscular electrical stimulation in healthy subjects. Exp Brain Res, 2003. 150(1) But does the same thing happen after stroke?
4. Bhatt, E., et al., brain reorganization and hand function in subjects with stroke. Exp Brain Res, 2007.
5. Kimberley, T.J., et al., Electrical stimulation driving functional improvements and cortical changes in subjects with stroke. Exp Brain Res, 2004. 154(4):
6. Shin, H.K., et al., Cortical effect and functional recovery by the electromyography-triggered neuromuscular stimulation in chronic stroke patients. Neurosci Lett, 2008.
7. Amorim BJ, Santos Ade O, Oberg TD, Romanato J, Anjos DA, Lima Mda C, Ramos CD, Honorato DC, Camargo EE, Etchebehere EC. Functional electrical stimulation improves brain perfusion in cranial trauma patients (with hemiplegia). Arq Neuropsiquiatr. 2011 Aug;69(4):682-6.
Estim effects botox
1. Hesse S, Jahnke MT, Luecke D, Mauritz KH. Short-term electrical stimulation enhances the effectiveness of Botulinum toxin in the treatment of lower limb spasticity in hemiparetic patients. Neurosci Lett. 1995 Dec 1;201(1):37-40.
2. Hesse S, Reiter F, Konrad M, Jahnke MT. Botulinum toxin type A and short-term electrical stimulation in the treatment of upper limb flexor spasticity after stroke: a randomized, double-blind, placebo-controlled trial. Clin Rehabil. 1998 Oct;12(5):381-8.
3. Bayram S, Sivrioglu K, Karli N, Ozcan O. Low-dose botulinum toxin with short-term electrical stimulation in poststroke spastic drop foot: a preliminary study. Am J Phys Med Rehabil. 2006 Jan;85(1):75-81. PubMed PMID: 16357552.
Evidence based Practice
1. Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn't. BMJ. 1996 Jan 13;312(7023):71-2. PubMed PMID: 8555924; PubMed Central PMCID: PMC2349778.
mCIT: reference articles
1: Modified constraint-induced therapy combined with mental practice: thinking
through better motor outcomes. Page SJ, Levine P, Khoury JC. Stroke. 2009
Feb;40(2):551-4. Epub 2008 Dec 24. PMID: 19109542 [PubMed - indexed for
MEDLINE] Related Articles
2: Modified constraint-induced therapy in chronic stroke: results of a singleblinded
randomized controlled trial. Page SJ, Levine P, Leonard A, Szaflarski JP,
Kissela BM. Phys Ther. 2008 Mar;88(3):333-40. Epub 2008 Jan 3. PMID: 18174447
[PubMed - indexed for MEDLINE] Related Articles Free article at journal site
3: Modified constraint-induced therapy extension: using remote technologies to
improve function. Page SJ, Levine P. Arch Phys Med Rehabil. 2007 Jul;88(7):922-7.
PMID: 17601475 [PubMed - indexed for MEDLINE] Related Articles
4: Modified constraint-induced therapy in patients with chronic stroke exhibiting
minimal movement ability in the affected arm. Page SJ, Levine P. Phys Ther. 2007
Jul;87(7):872-8. Epub 2007 May 1. PMID: 17472950 [PubMed - indexed for MEDLINE]
Related Articles Free article at journal site
5: Modified constraint-induced therapy in acute stroke: a randomized controlled
pilot study. Page SJ, Levine P, Leonard AC. Neurorehabil Neural Repair. 2005
Mar;19(1):27-32. PMID: 15673841 [PubMed - indexed for MEDLINE] Related Articles
6: Modified constraint-induced therapy: a promising restorative outpatient
therapy. Levine P, Page SJ. Top Stroke Rehabil. 2004 Fall;11(4):1-10. Review. PMID:
15592985 [PubMed - indexed for MEDLINE] Related Articles
7: Modified constraint-induced therapy and botulinum toxin A: a promising
combination. Page SJ, Elovic E, Levine P, Sisto SA. Am J Phys Med Rehabil. 2003
Jan;82(1):76-80. PMID: 12510190 [PubMed - indexed for MEDLINE] Related Articles
8: Modified constraint-induced therapy in chronic stroke. Page SJ, Sisto SA,
Levine P. Am J Phys Med Rehabil. 2002 Nov;81(11):870-5. PMID: 12394999 [PubMed
- indexed for MEDLINE] Related Articles
9: Modified constraint-induced therapy after subacute stroke: a preliminary study.
Page SJ, Sisto S, Johnston MV, Levine P. Neurorehabil Neural Repair. 2002
Sep;16(3):290-5. PMID: 12234091 [PubMed - indexed for MEDLINE] Related Articles
10: Modified constraint-induced therapy in subacute stroke: a case report. Page
SJ, Sisto S, Johnston MV, Levine P, Hughes M. Arch Phys Med Rehabil. 2002
Feb;83(2):286-90. PMID: 11833037 [PubMed - indexed for MEDLINE] Related Articles
11: Modified constraint induced therapy: a randomized feasibility and efficacy study.
Page SJ, Sisto SA, Levine P, Johnston MV, Hughes M. J Rehabil Res Dev. 2001 Sep-
Oct;38(5):583-90. PMID: 11732835 [PubMed - indexed for MEDLINE] Related Articles