Hand and ArmTutor Instrumental in Constraint-Induced Movement Therapy (CIMT)

‘Use It and Improve It or Lose It’ is an axiom Substantiated by a paper on ”Arm Function After Stroke”
On November 22, 2011 the following coauthors Yukikazu Hidaka, a computer science PhD student in the USC Viterbi School of Engineering; Cheol E. Han, Brain and Cognitive Sciences, Seoul National University; and Steven L. Wolf, Department of Rehabilitation Medicine, Emory University, principal investigator wrote the following:
“Use it and improve it or lose it” is an axiom of motor therapy—physical therapy that relates to the muscles that induce movement—for people recovering from a stroke. Yet the interactions between arm function and use in people who have had a stroke are still poorly understood.
A paper that explores these interactions, coauthored by two faculty members of the USC Division of Biokinesiology and Physical Therapy—Dr. Nicholas Schweighofer, associate professor, and Dr. Carolee J. Winstein, professor—has been accepted for publication in PLoS Computational Biology, the leading journal of computational biology.
“Use it and improve it or lose it: Interactions between arm function and use in humans post-stroke” describes how the research team developed a model of stroke recovery using data from EXCITE clinical trial participants who had received constraint-induced movement therapy (CIMT)—physical therapy that improves stroke patients’ arm function by restraining the use of the non-affected arm and increasing the use of the affected arm. (EXCITE—Extremity Constraint-Induced Therapy Evaluation—was a single-blind, randomized, multisite clinical trial involving 222 stroke patients, conducted at seven U.S. academic institutions between 2001 and 2006.)
The authors looked at arm-function data for a two-year period, starting three months or more after the clinical trial participants had their stroke. After systematically comparing their model with other models that either did or did not include interactions between arm function and use, the authors concluded that the data substantiated the “use it or lose it” axiom.
In addition, by comparing the model parameters before and after the CIMT intervention one year later, the researchers found that an increase in patients’ confidence in using the arm during therapy appeared to positively affect recovery after therapy.
The authors’ long-term goal is to develop and validate a method based on such models, to allow clinicians and patients to make informed decisions about treatment and potentially determine the critical dose of motor therapy for individual patients.
One of the foremost tools used in constraint-induced movement therapy (CIMT) is the HandTutor/ArmTutor.
Modifying constraint induced movement therapy is needed as up to approximately 35% of the population suffers from chronic stroke. This is because the patient does not have the motor sensory and cognitive movement ability to do the functional tasks. In other words if you can not grasp a cup how can you be expected to work on repetitive grasp tasks. This repetitive functional task exercise is the basis of Constraint Induced Movement Therapy. By the same token if the patient wants to work on the “good” limit of their movement ability e.g they have a deficit in speed of movement and can not make fast movments or they lack several degrees of movement in extension or flexion then again how do you customize a functional task to cover these impairments.
The Hand/ArmTutor system allows for the customization of exercise tasks to a level that allows patients with severe movement dysfunction to start intensive exercise practice with their impaired hand. The Hand/ArmTutor system has been proven to improve patient functional upper extremity movement ability in both patients with severe and moderate movement dysfunction.
The Hand/ArmTutor system intensively trains simple movement parameters using isolated exercise practice. The tasks can be set according to the individual patients limits of movement ability and the difficulty of the tasks can be shaped. The feedback gives the patient information on their performance of the tasks and instructions on how to improve their movement. Instruction and feedback is part of the learning cycle and the HandTutor system teaches the patient how to move their arm.
The HandTutor and its sister devices (ArmTutor, LegTutor, 3DTutor) are available for children as well as adults and are fully certified by the FDA and CE. See www.HandTutor.com for more information.