The American Journal of Occupational Therapy 321 Mental Practice as a Gateway to Modified Constraint-Induced Movement Therapy: A Promising Combination to Improve Function KEY WORDS • function • mental priming • modified constraint-induced movement therapy (mCIMT) • stroke S troke, the leading cause of disability in the United States (American Heart Asso- ciation, 2004), causes motor deficits that compromise quality of life (Bamford, Dennis, Sandercock, Burn, & Warlow, 1990) and lead to considerable care costs (Dobkin, 1995). However, increased use and function of the more-affected arm have been reported after people with chronic stroke (>1 year after stroke) partici- pated in constraint-induced movement therapy (CIMT) (Miltner, Bauder, Sommer, Dettmers, & Taub, 1999; Taub et al., 1993; Van der Lee et al., 1999; Wolf, LeCraw, Barton, & Jann, 1989). The most well-recognized variant of CIMT has emphasized massed practice with the more-affected upper limb in two ways: (a) participants’ less-affected upper limbs are restricted during 90% of waking hours of a 2-week period, and (b) participants engage in 6-hr activity sessions using their more- affected limbs on the 10 weekdays of the same 2-week period. However, CIMT may be difficult to implement clinically because of its demanding contact time and expense and patients’ lack of compliance and interest (Page, Levine, Sisto, Bond, & Johnston, 2002). Consistent with these concerns, a CIMT trial by Van der Lee and colleagues (1999) stated that most participants found CIMT participation strenuous. Simple shortening of CIMT contact time has proven to be a straightforward, efficacious solution to CIMT limitations (Pierce et al., 2003; Sterr et al., 2002). The most well-studied example has been modified constraint-induced movement therapy (mCIMT), which combines structured, 30-min, functional practice ses- sions using the more-affected arm, with restriction of the less-affected upper arm 5 days per week for 5 hr per day, both during a 10-week period. Besides its ability Stephen J. Page, PhD, FAHA, is Director of Research and Associate Professor, University of Cincinnati Academic Medical Center, and Director, Neuromotor Recovery and Rehabilitation Laboratory, Drake Rehabilitation Center, Cincinnati. Mailing address: Department of Rehabilitation Sciences, University of Cincinnati, 3202 Eden Avenue, Suite 275, Cincinnati, OH 45267-0394; Stephen.Page@uc.edu Peter Levine, PTA, is Senior Research Assistant, University of Cincinnati Academic Medical Center, and Co-Director, Neuromotor Recovery and Rehabilitation Laboratory, Drake Rehabilitation Center, Cincinnati. Valerie Hill, MS, OTR/L, is Research Occupational Therapist, University of Cincinnati Academic Medical Center. Modified constraint-induced movement therapy (mCIMT) is a reimbursable regimen that improves the use and function of more-affected arms in patients who have had a stroke. To participate in this regimen, however, patients must exhibit active extension of the more-affected wrists and fingers, which renders many people inel- igible. This study determined the efficacy of a mental practice program that preceded mCIMT in improving more-affected arm function in 4 patients with a stroke. Patients received therapy emphasizing activities of daily living (ADLs), followed by sessions of mental practice of the ADL. One week after completing mental practice, patients participated in mCIMT. After mental practice, patients exhibited marked changes on assessments and increased active wrist and finger extension, which qualified them for mCIMT. After mCIMT, participants exhib- ited additional functional gains, sustained 3 months later. Data suggest that mental practice provides a path- way whereby patients can participate in mCIMT, realize additional gains, and again perform valued ADLs. Page, S. J., Levine, P., & Hill, V. (2007). Mental practice as a gateway to modified constraint-induced movement therapy: A promising combination to improve function. American Journal of Occupational Therapy, 61, 321–327. Stephen J. Page, Peter Levine, Valerie Hill Downloaded From: http://ajot.aota.org/ on 12/03/2015 Terms of Use: http://AOTA.org/terms