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The Info Some Researchers Make Me Mad | Health News
Kitago concluded two weeks of constraint-induced movement therapy (CIMT) promoted task-specific compensation rather than decreasing motor impairment (1). Compensation means substituting for something that has been lost. Kitago and his associates came to this conclusion because stroke survivors got better at moving blocks and marbles, but couldn't transfer the movements CIMT taught them to a drawing task. The drawing task was difficult because it required
exquisite wrist control while arm movements were constrained by a sheet of glass.
Another study used a different approach. Raghavan recorded hand movements with a motion capture device called the CyberGlove while able-bodied people and stroke survivors grasped three different shaped objects (2). Able-bodied people did a better job of contouring the shape of their hand to the shape of the object than stroke survivors. Able-bodied people contoured their hand to the shape of objects by bending the 2nd knuckle of each finger (PIPs) while stroke survivors bent the 1st knuckle (MPs). Would increasing PIP flexion improve stroke survivors' grasp of objects with different shapes?
I understand what the first study is saying about transfer. It is difficult for me to use a hand movement in an unfamiliar position unless I've practiced it. However, able-bodied people also have trouble transferring motor skills when they work at the UPPER limit of their ability. NASA trains astronauts to make repairs by having them practice on exact duplicates of equipment they will work on during a spacewalk. Every tennis player does not play equally well on clay, grass, and concrete courts.
Bottom Line: I don't want treatment approaches
dismissed by bad science. Lets study the efficacy of CIMT using observation instead of by making inferences about transfer from simple to difficult tasks.
Annotated Bibliography
1. Kitago, T., Liang, J., Huang, V., Hayes, S., Simon, P., Tenteromano, L., Lazar, R., Marshal, R., Mazzoni, P., Lennihan, L., & Krakauer, J. (2013). Improvement after constraint-induced movement therapy: Recovery of normal motor control or task-specific compensation?
Neurorehabilitation and Neural Repair, 27(2), 99-109.
If these doctors had observed stroke survivors struggling with manual tasks they would have known the drawing task was an unrealistic outcome measure for just two weeks of treatment.
Motor learning is task-specific. Being a tennis champion does not make you a ping pong champion. That does not mean all task-specific motor learning = compensation.
2. Raghavan, P., Santello, M., Gordon, A., & Krakauer, J. (2010). Compensatory motor control after stroke: An alternative joint strategy for object-dependent shaping of hand posture.
Journal of Neurophysiology, 103, 3034-3043.
Motion capture technology could answer an important question. Does CIMT help stroke survivors generalize reaching and grasping to a wide variety of locations or do objects have to be placed in the one location the limb synergies permit movement?
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