Shruti Sonni, MD

Taub E, Uswatte G, Mark VW,Morris DM, Barman J, Bowman MH, et al. Method for Enhancing Real-World Use of a More Affected Arm in ChronicStroke: Transfer Package of Constraint-Induced Movement Therapy. Stroke. 2013.

Constraint- Induced Movement therapy (CI) for the upper- extremity has shown benefit in post-stroke and cerebral palsy patients, and has suggested benefit in traumatic brain injury and multiple sclerosis as well. In this study, 40 outpatient who were >1 year out with post-stroke hemiparesis were randomly assigned to four groups that differed in the type of training (shaping vs repetition), and presence/ absence of a set of techniques called the Transfer Package (TP). The TP involves behavioral techniques used to facilitate real-world application of therapeutic gains made in the lab by encouraging self-motivation and reinforcing practice at home of lab-learned skills.

Taub et al. were able to show that using TP resulted in 2.4 times increased spontaneous use of the affected arm regardless of type of training, and these gains persisted beyond 1 year post-treatment. A sub-study also showed that weekly phone contacts for the first month post-treatment bridged half the the gap between groups with and without TP.

This study reiterates the consensus that real-world functional activity is the most important outcome to pursue, and that use of TP facilitates this process. What makes this method attractive is that it does not involve longer therapist time or other expensive resources, but rather a more psychological approach towards the rehabilitation process. This is a good example of how a multidisciplinary effort between physicians, therapists and psychologists is key in achieving good functional outcomes in our post-stroke patients. The fact that four extra phone calls made a positive difference to outcomes goes to show that these patients need a long lasting system of support and encouragement.