Constraint-induced movement therapy for motor recovery after stroke.

A new therapeutic approach to rehabilitation of movement after stroke, termed Constraint-Induced (CI) Movement Therapy, has been derived from basic research with monkeys given somatosensory deafferentation. CI consists of a family of therapies; their common element is that they induce stroke patients to greatly increase the use of a more affected upper extremity for many hours a day over a 10-14 consecutive-day period. These therapies have significantly improved quality of movement and substantially increased amount of use of a more affected extremity in the activities of daily living in the life situation. The purpose of this paper is to describe the protocol used by the investigative team that developed the family of CI therapies and examined them as an effective rehabilitation approach.

The disabled driver: an unmet challenge.

A survey was undertaken to determine if driving impairment secondary to a disabling injury is addressed in state licensing laws and training programs. In 35 states drivers submit voluntarily to reevaluation after disabling injuries, but no provision is made for reporting such individuals. Only 15 states authorize physicians to report impaired drivers, and only seven require such reporting. Based on a survey of licensing bureaus in the capital or a major city of every state, clerks (who are likely to be the source of information to injured persons) are generally not aware of reporting requirements and supervisors are only slightly better informed. Of the 100 rehabilitation centers surveyed, only 36 provided on-site training for disabled drivers. Voluntary submission for reevaluation after head injury does not often occur. Despite being asked to do so, none of the 35 head injured patients, followed up to two years post-onset, sought reevaluation, although 21 had resumed regular driving. Two of the 21 were involved in subsequent traffic accidents. Common guidelines need to be established across states to ensure reevaluation of individuals with disabling conditions, delivery of accurate information concerning licensing, and availability of training programs.

Administrative physiatry.

Results of a mail survey of physiatrists and residents in physical medicine and rehabilitation indicate that physiatrists need administrative/managerial skills in their practices. For physiatrists to initiate new programs, they need skills in program planning and development, resource management, and similar areas. Experience gained as chief resident appears to have a positive bearing on gaining administrative/managerial skills. Similarly, experience in dealing with multidisciplinary treatment teams also seems to help. However, survey results indicate that formal training to acquire administrative/managerial skills or to lead multidisciplinary treatment teams is not offered in many residency programs. Physical medicine and rehabilitation residency curricula require that residents learn management techniques consistent with their team leadership roles. We suggest several methods of offering formal training to residents and to physiatrists in practice, via continuing education.