Learned non-use

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Learned non-use of a limb is a learning phenomenon whereby movement is suppressed initially due to adverse reactions and failure of any activity attempted with the affected limb, which then results in the suppression of behavior. Continuation of this response results in persisting tendency and consequently, the individual never learns that the limb may have become potentially useful.[1][2][3] By constraining the less-affected limb there is a change in motivation, which overcomes the learned nonuse of the more-affected limb.[1]

The principles of constraint-induced movement therapy (CIMT) used in stroke patients are based on the idea of the reversal of learned non-use.[4] CIMT uses constrained movement of the less-affected limb and intensive training of the paretic arm to counter-condition the nonuse of the more-affected arm learned in the acute and early sub-acute periods.[1][5] More recently, clinical versions of CIMT - called "modified constraint induced movement therapy" (mCIT) - have been produced that are administered over a longer time period than CIMT (usually 10 weeks). While offering the same effectiveness and cortical changes as CIMT, these versions are better tolerated, and can be integrated into traditional therapy clinics and reimbursement parameters.[6]

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  1. ^ a b c Taub, E., Uswatte, G., & Pidikiti, R. (1999). Constraint-induced movement therapy: A new family of techniques with broad application to physical rehabilitation. Journal of Rehabilitation Research & Development, 36(3), 1–21.]
  2. ^ Kunkel, A., Kopp, B., Muller, G., Villringer, K., Villringer, A., Taub, E., & Flor, H. (1999). Constraint-induced movement therapy for motor recovery in chronic stroke patients. American Academy of Physical Medicine and Rehabilitation, 80, 624–628.
  3. ^ Grotta, J. C., Noser, E. A., Ro, T., Boake, C., Levin, H., Aronowski, J., & Schallert, T. (2004) Constraint-induced movement therapy. Stroke, 35, 2699–2701.
  4. ^ Liepert, J., Miltner, W. H. R., Bauder, H., Sommer, M., Dettmers, C., Taub, E., & Weiller, C. (1998). Motor cortex plasticity during constraint-induced movement therapy in stroke patients. Neuroscience Letters, 250, 5–8.
  5. ^ Schaechter, J. D. (2004). Motor rehabilitation and brain plasticity after hemiparetic stroke. Progress in Neurobiology, 73, 61–72.
  6. ^ Page, S.J., Boe, S., Levine, P., (2013). What are the "ingredients" of modified constraint induced therapy? An evidence-based review, recipe, and recommendations. Restorative Neurology and Neuroscience, 31, 299-309.