In 1985 I remember working with the two year old daughter of a physical therapist who had had a stroke at birth.  I noticed that she crawled using one arm and not the other.  Immediately my thought was to stop the arm that was moving (constraining it) and support her moving through her torso  – equalizing the function of both arms.  That means that the arm working was doing only what the limited arm could do.

 In my mind I was stimulating this girl’s brain to remember that she had two arms by reducing the use of the one and increasing the use of the other—starting with what she could do with the arm with limitations. By gently restraining both arms, we crawled on our upper arms and elbows, maximizing the function of the torso and legs.  This was fun and novel for her.  After a few minutes she started to explore using the arm that initially didn’t want to participate. 

My belief was that the more attention she gave to moving in a functional way with both arms – the more two arms would be represented in her mind-body map and the more the second arm could and would start to function.  The trick was to not let the more capable arm show off.  

Recently studies show the functional importance of constraint movement therapy. What is different is that I did not force the non-functioning arm to do an action.  I put the restraint into a full functional action with a feeling of novelty and play. 

***Visit: Constraint therapy with children:

http://www.chasa.org/ci.htm      OR

http://www2.cochrane.org/reviews/en/ab004149.html

with adults:

http://www.strokeassociation.org/STROKEORG/LifeAfterStroke/RegainingIndependence/PhysicalChallenges/Constraint-Induced-Movement-Therapy_UCM_309798_Article.jsp