Constraint-induced movement therapy in stroke rehabilitation: perspectives on future clinical applications

Results from studies supporting the application of constraint-induced movement therapy (CI therapy) in patients with stroke have steadily increased over the past decade. The exploration of this intervention has provided a broad foundation from which to build further development of evidence-based practice in neurorehabilitation. This article first provides an update on CI therapy efficacy based on the relative chronicity of stroke and the functional levels of participants from whom data have been acquired. A review of current considerations is discussed, including guidelines for screening criteria, the role of the patient and family during the intervention, options for various delivery modes and suggestions to monitor outcomes. Finally, future directions are explored through identification of integrated approaches with CI therapy including: robotics, virtual environments, mental imagery, pharmaceutical manipulations and cortical stimulation. Clinical application of a research based intervention should not occur in isolation. CI therapy researchers should be charged to define the critical aspects of this therapy and appropriate adjunctive interventions that augment its applicability and effectiveness.