The case for CI therapy.

Dear Editor: In a recent issue of this journal (vol. 40, issue No. 1, pp. vii–ix), Alexander Dromerick, MD, contributed an editorial on " Evidence-based rehabilitation: The case for and against constraint-induced movement therapy. " We strongly endorse the first part of the editorial that speaks to the importance of basing clinical practice in neurorehabilita-tion on a solid foundation of experimental evidence. In the second part of the editorial , Dr. Dromerick states that there is insufficient data to permit the conclusion that CI therapy is an effective therapy and that the data available are " unconvincing. " We are puzzled by this opinion, since Dr. Dromerick is the medical director and main professional figure of a clinical CI therapy program at the Stroke Center of Barnes-Jewish Hospital, Washing-ton University School of Medicine. As of the submission of this letter, the web site (www.neuro.wustl.edu/ smart/citp.htm) representing Dr. Dromerick's program states, " In our research we have found that the group treated with CI therapy showed significantly improved hand function when compared to those treated with standard rehabilitation techniques. " Moreover, prospective patients are informed that " our goal is to help you learn how to use your arm more during your everyday life. " We understand the enthusiasm for the results of CI therapy that must have underlain Dr. Dromer-ick's decision to open a clinic to provide this intervention. Six reasons might be mentioned: 1. Controlled experiments. In an initial study, the CI therapy group (n = 4) showed large improvements in real-world arm use and arm motor ability relative to a placebo control group (n = 5) [1]. These results were confirmed in a larger study with a fitness training control group (n = 20) who received the same amount of therapist attention and time in motor training as the CI therapy group (n = 21) [2]. Three months after the end of their placebo intervention , the fitness training control subjects were crossed over to CI therapy and displayed a similarly large motor improvement. 2. Replications. The results from this laboratory have been repli-cated with quantitatively similar results in studies from three other laboratories [3–5]. In one of the replications [3], the experimental intervention was compared to a no-treatment control period; no changes occurred over the control period. 3. Successful transfer to clinical settings. To date, approximately 150 research participants in our laboratory and over 120 patients in …