Dr. Edward Taub surgically induced a stroke in monkeys and then he tied their good hand to see how much recovery they would get. Some animal rights activists let some of these monkeys free because they thought that tying the good hand was torture. The monkeys that were freed from the hand restraints didn’t get back as much function as the ones that were forced to use their stroke affected hand. What the animal rights activists saw as torture actually helped the monkeys recover the use of both hands.
In the first few weeks and months after stroke, many people don’t use their affected hand. They can use their unaffected hand to wheel the wheelchair and eat. There isn’t much therapy that encourages the use of the affected arm and hand.
In the first few days and even weeks after stroke, many stroke survivors spend much of their time alone either resting, or sleeping. This according to Taub, results in “learned non-use” of the arm and hand. Edward Taub and his group restrain stroke survivors’ unaffected hand with a mitt. They ask stroke survivors to work with the therapist and use their affected hand for many hours a day to do normal functional tasks like turning pages, picking up pennies, or even eating and drinking.
Constraint therapy is one of the most successful therapies currently in use to regain upper extremity function, AND since 2001 constraint therapy has also been used in the treatment of aphasia.
Pulvermüller’s group in Germany were the first to suggest that withdrawal from communication (not talking), change of communication strategies (letting someone else talk, saying as little as possible) and use of compensatory strategies (communicating by writing words with a pad and pencil), adopted by many patients with poststroke aphasia could be viewed as forms of learned-non-use in patients with aphasia.
They suggest that constraint based principles could be used to help people communicate better. Not everyone calls it constraint therapy. Different work-groups call it:
- constraint-induced language therapy
- constraint-induced aphasia therapy
- intensive language-action therapy
The constraint therapy aphasia research demonstrates that even many years post stroke, intensive aphasia therapy can help people with aphasia improve their communication skills.
However, speech scientists don’t know which of the various factors used in constraint therapy make the most difference: constraint, forced use, intensity, duration, or the communicative environment. More research is definitely warranted. Since there is not an animal model for aphasia, it has to be done with people!
Ask the Heart and Stroke Foundation and the Canadian Stroke Network what type of aphasia research they have funded, are funding, or might be funding.
Or, if you have aphasia and you don’t care which of these factors are most effective helping people regain their communication skills, the InterACT program at Dalhousie in Halifax offers intensive aphasia treatment.
More information about constraint therapy:
- Meinzer 2011 First Decade of Research on Constrained-Induced Treatment Approaches for Aphasia Rehabilitation
- Holland 1991 Practical Aphasia Treatment
- Pinter & Brainin 2012 Rehabilitation after stroke in older people
- Edward Taub et al 1999 Constraint-Induced Movement Therapy
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