Stroke Recovery: Immobilization... Video Transcri...

Participants

David Alexander MD, David R. Marks MD, Richard D. Zorowitz MD

Summary

There has been a lot of talk recently bout "immobilization therapy or constraint induced therapy which is a eehabilitation strategy for stroke patients experiencing mobility problems. This intensive therapy, in which a working limb is immobilized to improve the function of an impaired one, actually dates back to the early 1900's. How does this therapy work, and why is it making a comeback? Join our two experts as they discuss their new understanding of this old therapy.

Webcast Transcript

DAVID R. MARKS, MD:  Hi, and welcome to our webcast.  I'm Dr. David Marks.  If you or someone you know is having trouble moving after a stroke, you may have noticed a number of recent news reports on a type of treatment called immobilization therapy, or constraint-induced therapy.  This intensive therapy, in which a working limb is immobilized to improve the function of an impaired one, actually dates back to the early 1900s.  How does this therapy work and why is it making a comeback?

Joining us today to discuss these new therapies, which are actually old therapies, are two experts.  First is Dr. Richard Zorowitz.  He is director of stroke rehabilitation at the University of Pennsylvania.  Welcome.

RICHARD ZOROWITZ, MD:  Thank you.

DAVID R. MARKS, MD:  From Los Angeles, California, is Dr. David Alexander.  He is the medical director of the Daniel Freeman Rehabilitation Center in LA.  Welcome.

DAVID ALEXANDER, MD:  Thank you.

DAVID R. MARKS, MD:  What is immobilization therapy?

RICHARD ZOROWITZ, MD:  Immobilization therapy is a therapy in which the good arm is immobilized -- that is, put in a splint, in a cast so it can't move, forcing the patient to be able to use their bad arm in various activities intensively, somewhere around six to seven hours per day for a two week period.

DAVID R. MARKS, MD:  Why the heck would you do that?  It sounds like something that wouldn't be very logical.

DAVID ALEXANDER, MD:  It forces use of the affected limb.  For example, if you're not able to use your hand or leg, it forces you to use it, and some of the problem with a weak arm is that people learn not to use that.  We call that "learned non-use."  This may overcome that.  Forcing people into using that may help the brain recover and people recover better from a stroke.

DAVID R. MARKS, MD:  Is this done right away?

RICHARD ZOROWITZ, MD:  Usually, the studies that are being done right now are being done in patients who have had a stroke at least a year ago, although there is some interest in trying to do studies on these patients much earlier than that.

DAVID R. MARKS, MD:  You had mentioned two weeks, a two week period.  Explain that.

RICHARD ZOROWITZ, MD:  This is based on a research study where it's a two week design of intensive therapy for two weeks.

DAVID R. MARKS, MD:  Two weeks to overcome a year of non-use?

RICHARD ZOROWITZ, MD:  Yeah.  It's very intensive therapy.  It's six to eight hours to day for those two weeks.  It really, in a way, is what we do in rehabilitation therapy in general, which is to try to incorporate the affected part of the body.  If the arm is not work well, trying to get that to work together with the rest of the non-affected side and get it to work.  So I don't actually think the general principle is all that different from rehabilitation, but some recent studies have really pointed out that this can be effective, even late after a stroke.

DAVID R. MARKS, MD:  I mentioned earlier that this is a new therapy, and yet it's really an old therapy.