Recoveryinterventions.com
A practice for the Clinical Application of Forced Use to enable the recovery of motor control in stroke and brain injury and an educational program for forced use handling strategies
susan woll
jan utley
Wehntaler Strasse 58
Zuerich 8057
ph: +41.79.740.2444
Our Method of Treatment/Handling
We,at Recoveryinterventions have developed a methodology for the "Clinical Application of Forced Use Management Strategies" for clients with minimal function in the involved body segments. The majority of clients with Hemiplegia and Head Injury have severe forms of motor dysfunction as a result of Brain Trauma. In our experience with treatment, these clients have the potential for recovery of motor control under very specific conditions of practice and training.
Unlike clients participating in the Constraint Induced Movement therapy (CIMT)research, who have enough movement to successfully engage in massed practice with only verbal feedback, the clients with extreme limitations require a different management regime.
We at Recoveryinterventions, work with clients with more severe limitations for six hours per day for two, three or four weeks of intensive training. Each day begins with one to two hours of treatment, which includes mobilization for the orthopedic contraints resulting from immobility, followed by handling in activities utilizing forced use strategies. The handling strategies include activation of skeletal muscle in weight bearing and strengthening of all of the involved body segments. This is necessary in order to prepare the client to engage in Massed Practice in functional patterns of movement.
As utilized in the Forced Use research, all of the treatment activities force the client to use the involved body segments while disallowing the overuse of the non-involved body segments. The clients are required to use the involved arm in eating or drinking during the six-hour day.
In the afternoon clients engage in Massed Practice which includes activities which emphasize the use of the involved are and leg with a high number of repetitions as suggested by the neuroscience research to enable the new patterns of movement to be integratedand learned.
In these activities the clients require manual feedback to guide and define the movement parameters in the function as the client regains motor function the manual feedback is gradually reduced.
We began treating in this way in 1998 with a client from Germany who then received treatment over a four year period for a total of 16 weeks of this type of intensive therapy. This client was one year post CVA and had no function in the involved arm. The entire shoulder and arm were hypotonic and the hand was closed and was hypertonic. At the end of the sixteen weeks the client had regained motor control in the involved arm including fin motor control in the hand.
Since the summer of 2002 when we conducted a 12 week research project in Los Angeles, California, with severely involved clients with chronic hemiplegia we have utilized forced use management strategies. As a result we have recognized that all of the clients with this type of motor dysfunction have the potential for recovery of motor function.
Under the conditions of practice and training described above every one of our clients has achieved significant recovery of motor control in the involved body segments.
The difference in our approach and treatment as opposed to traditional therapy and the CIMT is that we have utilized information from the research in Neuroscience and neuroplasticity to develop highly effective forced use handling/management strategies for the more severe client.
We have formed an international association for Forced Use Specialists...we have done this not only to protect our clients but also our method of handling...so that you as clients and therapists can distinguish your selves and your treatment from other forms of Management. Our organization is known as : International Forced Use Specialists Association...look for us at our new website...www.IFUSA.info
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Wehntaler Strasse 58
Zuerich 8057
ph: +41.79.740.2444