constraint-induced movement therapy and cam … · 6/8/2014 1 constraint-induced movement therapy...
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Constraint-Induced Movement Therapy and CAM Physical Treatments
Victor W. Mark, MDUniversity of Alabama at Birmingham
Departments of Physical Medicine and Rehabilitation,Neurology, and Psychology
Gary Cutter, PhD
Data and Safety Monitor Board:
Corporate President:
Pythagoras, Inc (private consulting company, Birmingham AL)
The other investigators of this research declare no conflicts of interest.
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• National Multiple Sclerosis Society (RG 4221)
• National Institutes of Health (HD061767
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• Massed practice
• Restraint
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• Shaping
Less‐affected hand wears restraining mitt
More‐affected hand practices improving ball transfer in small increments with therapist encouragement
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• Transfer Package
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From Gauthier LV et al, Stroke 2008.
Gauthier LV et al, Stroke 2008.
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0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
4.5
5.0
Pretreatment Post 6 mos 1 yr 2 yr 4 yr 5 yr
MAL
Time
Change in Upper Extremity Real World Arm Use with CI Therapy
Mark VW et al, Int J MS Care 2012 (abstract)
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0
1
2
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Pre Post
Change in MAL
CI CAM
Effect Sizes
CI Therapy 3.7
CAM 0.7
0
1
2
3
4
5
Pre‐wk Post
CI therapy
0
1
2
3
4
5
Pre‐wk Post
CAM
Mean change 2.7SD 0.7Effect Size 3.7
Mean change 0.5SD 0.8Effect Size 0.7
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Significant cortical grey matter growth only shown by CI therapy patients (p < 0.02)
Stroke MS
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0
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Pre Post 4 wk 6 mo 1 yr 2 yr 4 yr
LE‐M
AL
Time in relation to therapy
Change in Lower Extremity Real World Leg Use with CI Therapy (Mark VW et al, Arch Phys Med Rehabil 2013)