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Principles of Constraint-Induced Treatment

Irene Barrow, PhD, CCC-SLP

January 19, 2015

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Question

What are the main principles of constraint-induced treatment?

Answer

According to a review of the literature by Meinzer and colleagues (2012) there are four main principles for constraint-induced treatment: nonuse, massed practice, shaping, and behaviorally relevant treatment.  Nonuse follows the principle of “use it or lose it.”  Initially, the nonuse is thought to be due to diaschisis (i.e. a sudden loss (or change) of function in a portion of the brain connected to a distant, but damaged, brain area).  However, once the acute stage subsides, that nonuse may linger due to inhibitory effects from the interconnected areas that prevent the residual skills from being used. 

The second concept is massed practice, which involves (1) a high volume of repetitions, (2) performed in a large chunk of time, and (3) performed over a sustained period of consecutive days.  It is a very intensive form of treatment. 

The third principle is shaping of the desired behavior via increments that become increasingly difficult relative to when the behavior was introduced.  There is a continuous expansion of the skill to more complex levels and higher standards of achievement.  This part of the treatment is much like behavioral modification paradigms where we are gradually shaping the behavior into the desired result. 

The final component ties into the idea that the environment in which the skill is practiced must be relevant and as close to spontaneous demands as possible. 

The general conclusions across the studies that were reviewed were that the CI treatment, when compared to some other form of treatment, resulted in greater improvement, especially in day-to-day communication.  

Dr. Irene Barrow obtained her B.S. and M.A in Communication Sciences and Disorders from Central Michigan University in 1982 and 1983 respectively. She received her doctoral degree from East Carolina University in 2001. Her research interests are in neurolinguistics with a special interest in mild traumatic brain injury. Currently, she teaches a variety of online courses for several universities.


irene barrow

Irene Barrow, PhD, CCC-SLP

 Dr. Irene Barrow obtained her B.S. and M.A in Communication Sciences and Disorders from Central Michigan University in 1982 and 1983 respectively. Following years of working clinically, she returned to academia and received her doctoral degree from East Carolina University in 2001. Her research interests are in neurolinguistics with a special interest in mild traumatic brain injury. Currently, she teaches a variety of online courses for several universities.


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