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KMID : 0614720130560010038
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Journal of Korean Medical Association
2013 Volume.56 No. 1 p.38 ~ p.44
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Constraint-induced movement therapy
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Kim Min-Wook
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Abstract
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Upper extremity paresis is a major impairment after stroke. Constraint-induced movement therapy (CIMT), which is in contrast to traditional rehabilitation techniques, such as neurodevelopmental approaches and proprioceptive neuromuscular facilitation, has initiated evidence-based medicine in stroke rehabilitation research. The main components of CIMT include massed practice, the constraint of movement of the intact upper limb, and the shaping of the behaviors of the impaired limb in order to improve the amount and quality of the use of the impaired limb. The proposed mechanism for CIMT involves overcoming learned nonuse and plastic brain reorganization. Patients who are indicated for CIMT have ≥10° of active wrist extension, ≥10° of thumb abduction/extension, and ≥10° of extension in at least 2 additional digits. The standard CIMT is a time-consuming and labor-intensive treatment in the clinical situation. A modified CIMT has been studied to eliminate the limitations of the original method. Further studies should be performed to determine the amount, dose, training, and restraint technique of CIMT. Future studies also need to explore the synergy between CIMT and new therapies, such as robotics, virtual environments, mental imagery, and cortical stimulation. As an essential strategy founded on evidence-based medicine and proposing a conception of specific training for selected patients, CIMT should be further studied in terms of its applicability and effectiveness.
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KEYWORD
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Physical therapy modalities, Stroke, Recovery of function, Upper extremity
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