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| Rebecca Dutton Home After a Stroke |
When a new graduate told a blogger that stroke recovery happens in the first two years I decided to write about constraint therapy. It was designed by a psychologist named Edward Taub who did not assume recovery after a stroke is time limited. Briefly, constraint therapy means putting a mitt on the sound hand during 2 hours of therapy for the hemiplegic hand PLUS leaving the mitt on the sound hand for 3 to 6 hours each day. This forces the hemiplegic hand to work. Since 1993 many constraint therapy studies have found clients can recover hand function for years after a stroke.
Constraint therapy is good because it challenged long held beliefs about stroke recovery. Constraint therapy is bad because it was designed by a man who grew up in a culture where men can expect women to take care of them. It would be nice if husbands would go grocery shopping, cook, and do laundry while wives constrain their sound hand every day.
Current research offers an alternative. Hayner found guiding both hands to work while making lunch, eating, and cleaning up helped stroke survivors improve as much as subjects whose hand was constrained during the same activity (1). Hayner concluded the duration of forced hand use is what matters. Sterr reported a similar finding (2). Stroke survivors who were helped to use their hemiplegic hand for 90 or 180 minures improved as much as subjects who received constraint therapy for the same amount of time.
How can stroke survivors ensure this much hand use? I do exercises with a spring-loaded splint called SaeboFlex that helps me open my hand 100 times. Now my hemiplegic hand can open to hold over 100 objects while my sound hand manipulates those objects. Brief hand use adds up. In 11 years my hemiplegic hand has opened to hold a tube of toothpaste 16,060 times so my sound hand can take the cap off and put the cap back on after I put toothpaste on my toothbrush. Bottom Line: More than one type of forced use can improve hand function years after a stroke. Rehab professionals and stroke survivors need to let go of old myths.
- Hayner K, Gibson G, Giles G. Comparison of constraint-induced therapy and bilateral treatment of equal intensity in people with chronic upper-extremity dysfunction after cardiovascular accident. American Journal of Occupational Therapy. 2010;64(4):528-539.
- Sterr A, Oneill D, Dean P, Herron K. CI therapy is beneficial to patients with chronic low-functioning hemiparesis after stroke. Front. Neurol. 2014;5:
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