also
known as constraint-induced movement therapy, movement-induced
therapy according to Taub and ci-therapy
1. What is 'Forced Use'?
The term originates from therapeutical research and describes
a treatment successfully applied to patients suffering from
hemoplegia after having a stroke: the healthy limb is artificially
rendered 'unusable' for the duration of the treatment (fixated
to the body with bandages). That way, the client is 'forced'
to use the affected limb in order to fulfill the assigned training
movements. In 'forced use', the encouragement to move is mainly
achieved with oral feedback by the therapist.
2. What's the goal of 'Forced Use'?
The goal is increased and improved use of the affected limb
in everyday-situations and the recovery of original functions.
That's why you will
- learn how to execute a certain movement (again) and
- be able to apply that movement independently on a regular
basis as well as
- achieve an improvement of motor functions.
3. What are the prospects for success and when can the therapy
be started?
During the first phase after the incident, success is visible
at the fastest, because 'learned non-use' of the affected limb
hasn't occurred yet – therefore an immediate commencement
of therapy would be ideal.
The prospects to improve and recover functions after strokes
dating a longer while back, are essentially the same. The only
limitations are orthopaedic changes which might have occurred
in the meantime, resulting in therapy needing a bit more time
to take effect.
4. How is 'forced use' applied in our treatment concept?
In our practice, we integrate the findings of the Bobath-concept,
'forced use', general brain research and the techniques of Manual
Therapy to achieve mobilisation: in our intensive therapy in
the area of neurology all advantages of the four approaches
are combined to become sci-Art™.
We create situations, where our clients h a v e t o u s e their
affected arm or leg. Supportive functions are carried out under
supervision of the therapist, handling of everyday-items is
included and functional work is done. During therapy, among
other things, we fixate the unaffected arm by means of bandages,
in order to 'force' you to use the involved arm. Much emphasis
is put on sensomotoric-functional individual treatment, where
arm and hand functions have to be used actively and goal-oriented
whenever possible.
5. Relevant factors for success
Your success in treatment depends on
- your motivation
- the behaviour of your relatives and
- existing orthopaedic interferences
You provide the determination to learn anew and to change.
We create sense of achievement and provide encouragement,
support and positive reaffirmation.
Take a look at our gallery to get an impression of the daily
routine in therapy.
6. Scientific background
Integration of 'forced use therapy' in our treatment concept
rests on three scientific and therapeutic foundations:
- the classic Bobath-concept
- most recent results from brain research and scientific
studies
Here, especially the work of Susan Woll and Jan Utley, both
Bobath-instructors from Los Angeles, is particularly relevant.
They were the first to combine therapeutic findings from
the enhanced Bobath-concept with elements of 'forced use
therapy'. They analyzed their findings scientifically and
the application in the rehabilitation of clients suffering
heavy motoric dysfunctions proved to be very successful.
>>more
- research results dating as far back as 1916, from Edgar
Taub during the seventies, taken up by Morrison in the nineties
and meanwhile adapted by many other scientists.
Edgar Taub, psychologist and neuroscientist, was able to
confirm findings from 1916 in the seventies. Experimenting
on monkeys, like his predecessors, he unveiled evidence
of the astounding capabilities to reorganize both of the
nervous system and the brain. The animals were able re-learn
the use of impaired extremities, even when suffering heaviest
neurological damage -hemoplegia like in stroke victims.
To achieve that, all there was to do, was to force them
to use their damaged limb (by bandaging the uninvolved arm)
over a longer period of time in order to eat, drink, walk
etc.
Taub's experiments proved, that non-use of a single extremity
is a learned behaviour und can be traced to a conditioned behaviour
suppression. Transferred to human beings, this means that neurological
damage and learned behaviour together result in non-use of a
single extremity. Experience during the first time after the
incident clearly plays a vital role here:
During the first time after a stroke (between only a few days
and up to 1-2 weeks, sometimes even longer) movement attempts
are carried out and – from the viewpoint of learning theory
- are punished with failure: i.e. The attempt to rise ends with
a fall from bed; Movement goals, like reaching for a glass of
water are missed etc. That's why this period is also called
phase of cortical shock. Afterwards, the patient will make fewer
and fewer attempts until finally the involved side is being
totally neglected during the day. Simultaneously, the patient
learns to conduct all necessary movements faster and more deliberately
with his uninvolved side: sense of achievement results in positive
affirmation. Compensation on the one hand and behaviour suppression
on the other, can additionally be encouraged by attachment figures
– with their best of intentions: Over-consideration reinforces
avoidance behaviour. The patient develops the 'learned non-use-syndrome'.
This kind of 'learning achievement' can be illustrated with
an example from a third world environment: After suffering a
stroke in countries without a safety net of social benefits,
sheer survival is at stake. One m u s t learn. Water has to
be fetched from the well, one's business has to be done while
standing up, there are no aids and helpful people to assist
in eating or getting ready are absent. Without therapeutic help,
only those absolutely vital functions like walking on even ground
and the ability to compensate will come back.
Thus, with stroke victims we have always to keep in mind that
there is 'learned non-use', but this can be overcome in different
situations with motivation, understanding and professional help
as well as with positive affirmation. The goal is increased
and improved use of the affected limb in everyday-situations
and the recovery of original functions. As memory aid we bandage
the uninvolved extremity.
 Forced
Use - A Handling Strategie von Susan P. Woll, PT und Jan Utley,
PT finden sie in unserem Download-Bereich
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