Constraint-induced therapies (CIT) evolved from the simple notion that much of the long-term disability of stroke survivors resulted from a learned tendency to avoid using the impaired limb. The term “learned non-use” describes the process as the survivor increasingly avoids using the impaired limb and is thus unable to capitalize on the value this limb might offer.
Principles of CIT
Based on this theory, a set of treatment principles was designed to counteract learned non-use and enhance the abilities of the impaired limb. The three treatment principles are:
- Constraint – avoid compensation, in this case, by tying down the good limb.
- Forced use – require the use of the impaired limb.
- Massed practice – require the constraint and forced use every day, all day.
CIT and aphasia
Recently, these same CIT principles have been applied to aphasia rehabilitation. In speech therapy, constraint means avoiding the use of compensatory strategies such as gesturing, drawing, writing, etc. Forced use means communicating only by talking; and massed practice refers to therapy occurring 2–4 hours per day.
Preliminary investigations suggest that CIT principles may be effective in aphasia rehabilitation. However, this investigation is only the beginning. So far, all we can say is that in some cases it appears to be helpful. Further study is needed.
Evaluating new treatment approaches
Before beginning any rehabilitation program, you should determine that the provider is qualified, informed and experienced. However, when considering a product or program that is new or experimental, such as CIT applied to aphasia rehabilitation, it is equally important to evaluate how the program is portrayed and the evidence that supports it. Testimonials on promotional materials and uncontrolled case reports are considered the lowest level of evidence and should be supported by research published in professional journals.
The American Speech-Language-Hearing Association (ASHA) provides a list of questions to guide you in evaluating new products or technologies. You’ll find it under the heading “What to ask your Audio."