Decades’ worth of research on constraint-induced movement therapy by UAB Professor Edward Taub, Ph.D., is receiving its day in the spotlight in one of science’s most respected publications.
The Journal of the American Medical Association published the results of a national, multi-site, randomized clinical trial Nov. 1, showing that CI therapy can help patients who have suffered injury to their central nervous system.
“The multi-site clinical trial represents the gold standard for evidence of effectiveness in the medical and health-care community,” Taub says, “and the results from the trial meet the gold standard for evidence of efficacy for CI therapy.”
The trial, which started in 2000 and was conducted by Emory University, consisted of six sites around the country, including UAB. Taub and his collaborators, led by Gitendra Uswatte, Ph.D., assistant professor of psychology, and David Morris, Ph.D., associate professor of physical therapy, trained therapists and testers at each of the sites. Taub and Uswatte were co-principal investigators for the UAB site.
CI therapy consists of a family of therapies. Their common element is that they teach the brain to re-wire itself following a major injury such as stroke or traumatic brain injury.
Following such injuries, the victim essentially learns not to use the affected limb in a condition Taub refers to as “learned non-use.” But his CI research has shown repeatedly that patients can reverse the learned non-use and improve the motor ability of the injured parts of their bodies and stop relying primarily or exclusively on the less-affected parts.
In CI therapy, a patient’s unaffected limb is restrained and the impaired limb undergoes intense training for many hours each day, five days a week, for two or three weeks. These therapies have improved quality of movement significantly and substantially increased the use of an affected extremity in common daily living activities for a large number of patients.
“Prior to our work, the traditional view in rehabilitation medicine has been that nothing could improve motor function in a patient who had experienced a stroke more than one year earlier. However, CI therapy offers hope to all of these people who have been told they are never going to improve, because that’s just not true,” Taub says. “They can be improved because we do it here at UAB all the time every day.”
Uswatte, whom Taub credits greatly for the work on the Emory trial, says earlier trials conducted at UAB and the Birmingham Veterans Affairs Medical Center have been with chronic patients – patients, that is, who are one year past a stroke incident.
“Two previous trials from our labs showed very positive results in stroke therapy,” Uswatte says. “This multi-site trial confirms the two trials we did here at UAB and shows that other places can replicate what we’ve done here and get similar, positive results.”
The results of CI therapy, which Taub first began implementing with humans a year after arriving at UAB in 1986, have been remarkable. Patients who at one time had lost the use of an arm began using their affected arm to dress themselves, write checks, sign their names, brush their teeth and comb their hair.
A placebo-controlled follow-up study reported earlier this year in Stroke showed CI therapy patients continued to benefit after two years.
CI therapy has helped people battling numerous health issues other than strokes. Cerebral palsy, spinal cord injury, hip fractures, multiple sclerosis, phantom limb pain and focal hand dystonia are just a few of the other conditions in which CI therapy has greatly helped patients. The cost for the therapy is expensive because it is so labor-intensive. Uswatte says costs can be reduced, however, thanks to automated workstations developed at the Birmingham VA and researchers at UAB.
“The workstations aid the patients with their CI therapy and only take about one-fourth of the therapist efforts that is required for the one-on-one training,” Uswatte says.
Happy for mentor
Uswatte, who studied under Taub before returning to UAB as a faculty member, said he’s happy to see decades’ worth of work and research by his mentor validated in this way.
Uswatte says Taub’s research demonstrated that sensory information is not necessary for motor control and challenged the dominant view at the time about how organisms control their movements.
“He’s also played a seminal role in the research that shows the adult brain is plastic, meaning changes in the organization of the brain take place even in adults. That’s all connected to this therapy,” Uswatte says.