Although the technique for achieving this reversal is not well known by the public, or most medical practitioners, the new method and results leading to such success have been demonstrated in numerous clinical studies and personal experiences (and I will provide you with the links so that you can look at them yourself).

a. Medical Drugs
b. Physical Therapy
c. Electronic Devices
d. Diet and herbal medicines
e. CIT

a. American Stroke Association
b. Fourteen Clinical Studies
c. Government Evaluation

a. Using a restraint
b. Kicking a ball
c. A counter-intuitive approach
d. Robotic devices

a. Balls and such
b. Riser chair
c. Treadmill
d. Parallel Bars
e. Leg restraint
f. Mirror therapy

a. Not a physical problem
b. Not a matter of will
c. What is mind?
d. Our OPPOSITE approach
a. Diversion
b. Relaxation
c. Breathing
d. Visualization

a. Our experiment
b. Our control

a. What you can do
b. What you should do
c. What will you do?

CIMT involves the "training of the paretic upper limb (six hours a day each weekday for two weeks) and restraint of the contralateral upper limb (90% of waking hours for 14 consecutive days) as described by Taub (1980)."

Okay - let us deal with some basic concepts:

a. Upper limb. We are talking about the affected arm and hand of a stroke victim. It can be either the right or left arm and hand. Initially Taub tried to also deal with the lower limb - as did other researchers - and while some clinics offer that service Taub and all the researchers that I found (with the exception of one) appear to have abandoned it. I will have more to say about this in a subsection.

b. Constraint. Can be putting the good arm in a sling or otherwise restraining it but most often we are talking about the patient wearing something like an oven mitt.

c. Time frame. Usually said to be two to three weeks but no definite criteria given for duration. The ideal is that the patient wears the restraint ALL the time for fourteen days except for sanitary purposes when going to the bathroom. It is probably not safe to use the restraint either - when using a walker.

To start studying about this - first read the following American Stroke Association report.

Note from the Heart and Stroke Association report that:

"CIMT patients showed �large to very large� improvements in the functional use of their affected arm in their daily lives.

"Those in the control group reported no change."

"At two-year follow-up, the CIMT group showed a large improvement in MAL scores compared to pre-treatment scores."

"Those in the placebo group displayed no significant changes."

"medical insurance does not reimburse for CI therapy. It costs about $5,000 for two weeks of treatment."

Now, look at this MUST WATCH video.

We will come back to the video's content later, but for the moment you should after watching the video then look at: Constraint-induced movement therapy following stroke: A systematic review of randomised controlled trials.

What I get from these 14 studies is that they all had VERY positive results. If you want to do some really heavy reading you can look at this Government Guidelines Study.

Yes, I am familiar with the contraindication literature that "Immediate constraint-induced movement therapy causes local hyperthermia that exacerbates cerebral cortical injury in rats."

In my mind, the two key words there are "immediate" and "rats". In the first place we are not dealing with rats and in the second we are not dealing with treatment 'immediately' after inducing a stroke. So, I say, so what?

The conventional wisdom has always been that if stroke therapy was not conducted in an immediate time window after a stroke - then it would be of no avail, and I am quite in agreement that one should get treatment, within one or two hours if possible. However, we are trying to address the case here where someone has had a stroke weeks, months, possibly years ago and are no longer making any progress. The past conventional wisdom has been that there is no hope for these people while these new studies show that the stroke can still be reversed.

Let us be clear about this, if the situation has progressed so far that there is absolutely NO MOVEMENT in the hand or arm - then there is probably nothing mCIT can do. But, that does not apply to many, many cases that most people think are hopeless.

There are many other new therapies being proposed, such as through stem-cell research, the use of robotics, electrical pulse incitement, and all sorts of drugs. The cost is often prohibitive and the availability to most people - nil.

What is being proposed here can be combined with other therapies and regimens such as diet, pharmaceuticals, meditation, physical therapy, and so forth. Prayer and meditation is good. I don't recommend any 'extreme' diet. Most any good balanced diet will do. Some people feel that physical therapy is absolutely necessary - but the studies showing that have generally been conducted by physical therapists and there are other studies that do not bear that out and it can just take time and effort away during the two week mCIT process. I absolutely do not recommend drugs except under a physician's direction and even then would prefer to see them curtailed as much as possible during this process.

If after having read this far and having verified from the links what is being said here - you do not think that mCIT is what you want then you should STOP reading this web page now.

Personally, with Velda (see the true story below) we have used mCIT by restraining her good leg (as described in the drill section) and spending many hours having her kick a ball while sitting in her riser chair. There has been extended disagreement in our group as to the necessity of her 'kicking' rather than just moving her foot.

The problem is that in walking - Velda drags her foot or walks on her toe. This has been unnoticable to other observers here but because my father was in the business of fitting remedial footwear and because I had to deal with my mother's toe walking after her hip surgery - I am concious of it. The question is how to get Velda to correctly lift and place her foot. I do not think that her pushing it along in exercise will do it. We have to get the nerve paths to execute a kick, and I think that the ball exercise that we have devised does that. This alone will not be sufficient to correct her walking but it is a step in the right direction - and we have some additional therapies available to us as described in the section under drills and equipment. Some of these are NOT RESTRAINT therapies and so therefore violate the brain, nervous system reconstruction principles that we wish to initially invoke. I therefore do not feel that these methods should be used during the ten day mCIT regimen although they can be very beneficial afterwards.

There is an additional RESTRAINT and drill method that we use - but it is so counterintuitive that I will not describe it here because it would seem so ridiculous to people that I would risk invalidating in their eyes everything else that I have written here.

Still another approach is the use of robotic and electrical impulse devices. The following are a couple of articles from the plethora about them but they are so expensive and beyond our obtaining them that I have not seriously researched whether they actually work or not.

Robotic arm

robotic_arm_for_stroke_victims.htm

Some of the clinics have these devices available and that is fine - so long as they are not just a gimic. I said that I would mention some of the clinics - so here is a good place to do it.

A California clinic

A clinic offering service

But there are studies to show that Stroke Survivors Walk Better After Human-assisted Rehabilitation

In part, it may come down to what you can afford. We could only afford to do it at home because the government and insurance companies are not presently about to pay for the kind of human one-on-one treatment that is necessary. There are just too many existing stroke victims out there that they are not about to step into that morass.

Therefore - if you are going to do it - then it is probably up to you.

What you are looking at is the classical CIMT procedure and the mCIT method that I am proposing is just the opposite. Why it is the opposite and how it works will take me a little while to explain.

First of all, most people will say that they understand that stroke is not a physical problem. They will say that - but they don't really understand it because the physical therapist will say that they still need to do manipulation of the body. The doctor will say that he needs to give a medicine to relax the muscles - and so forth. Maybe they will say that brain is another physical organ of the body, and that the cells have been damaged and that they need to be repaired or circumvented.

But no, the problem is in the mind. So what and where is the mind? Well, I am not going to go there. You don't have to believe what I believe - you only have to consider doing what we did. We all come from different backgrounds. I happen to have been trained by the Massachusetts Metaphysical College to become a Christian Science practitioner. I later took university graduate courses in subjects like psychoanalysis and worked in the field of psychiatric social work. And Rae, who worked with me to help develop the interpersonal techniques, trained in Hakomi Body Centered Psychotherapy and Hypnotherapy. I am not saying that all this gave us all of the answers - or any of the answers - but rather that it just shaped my viewpoint. Still, what works is what works and I can only report to you what I see working.

So, what is Mind? What is it that controls the body? We are talking here more about the mental-physical rather than the metaphysical. The mental and the physical. Not to worry - we won't go there. But still, everyone is saying the mind (whatever that is) is controlling the body. If it isn't - then the body is dead - or at least damaged. So, in some way they think the stroke victim has a 'damaged body' and they want to fix the body. I am just saying that we need to fix the mind and I know the doctor and his drugs and the physical therapist can't bear to hear that. But - let us look at how we can do it.

You looked at the video and you saw what they were doing with Buddy.
Try.
Try harder.
Use your will.

Nope - I am saying do the opposite. Reminds me of the fellow who met a caterpillar with a hundred legs and he asked the caterpillar how in the world he ever kept a hundred legs coordinated. The caterpillar thought about it - and could never walk again. Honestly, that is the answer. Don't think about it.

But that is the problem. If I tell you to NOT think about it - you can only think about it. If I tell you to NOT think about a pink elephant you will think about one. See - I told you to NOT think about one - and there you are - thinking about one. Stop it. Stop it RIGHT NOW! Quit thinking about a pink elephant. You can't do it. Are you still thinking about that pink elephant? Yes? Well stop it.

That is the stroke victim's problem. We don't want them to think about moving their hand - because just like the caterpillar - then they can't do it. You don't believe that - but in a few moments I will give you experiments to prove that it is so.

But first, how do we get the mind/body to do what we want it to do? How does the caterpillar get its legs to move correctly? If it can do that for a hundred - surely we can do it for two! This is how mCIT works. We tell the body that we want to move a ball and it will try to move it with the 'good' hand and then when the 'good' hand can't move it - it will try to find another way.

When we tell Velda to move back her foot the body trys every which way to do it. It tries moving her 'bad' foot by pushing it with her "good" foot. It tries moving it with her 'good' hand. It tries with her 'bad' hand. If she could stick out her tongue and move it with her tongue then the body would do that. The only pathway open is with the unrestrained 'bad' leg. So - the body searches for a way to do that and if we get a little movement (so tiny you can hardly see it) we say - "Great!" "Good show!" "You are doing it!" And we will try again.

But - we DON'T use will to coordinate the caterpillar feet. We have to ignore them - just like the caterpillar. So we use diversion. We have to think about something else. I have done it a hundred times.

"Velda - let go of that!"
Strain - struggle. She can't do it.
She can't stop thinking about doing it.
She can't stop thinking about the pink elephant.

"Here Velda, take these scissors."
Zip -and her hand lets go of what she is holding -
and reaches out to grab the scissors.
I snatch the scissors away.
Her hand goes back towards what she was holding.
I push forward the scissors.
Her hand goes toward the scissors.
Back and forth.
We laugh.
Then her hand is free.
She can take or leave either object.

Have you ever heard how they catch a monkey? The hunters take an orange and put it in a glass jug and chain the jug to a stake. The hunters then go away and the monkey comes down out of the tree to get the orange. It puts its hand into the bottle - but once it grasps the orange it can't pull it out and it isn't able to let go of the orange. The hunters return and the monkey screams in terror as they approach but it is unable to let loose of the orange and to run back up the tree.

Can we hold the monkey's good arm and offer it a banana - so that it will let go of the orange and take the banana? If so - that is called diversion. Anyway, that is what we do with people. They have to do it - and do do it - instead of thinking about it.

Stressing and straining will not help get the hand out of the bottle. It will only increase the terror.

We say, "Stop!" "Look at me!" "Take my hand!" Diversion - our number one tool. Relaxation - our number two. "Sit back and relax, Velda." "It is okay, you are doing well." (She may still be holding onto the object) Breathe!"" - our number three tool. "Take deep breaths - in and out - in time with me." The mystery of breathing. If we stop - then that is it. We breathe out - but then we don't breathe in. It is said we 'expire'. Yoga, Zen, Sufi, Meditation, Swedenborg, breath, life, nature of the soul, all so many things having to do with proper breathing. If people are excited, angry or tense - then you need to change their breathing. Sit back, relax, breathe - and visualize - our fourth tool. Perhaps not good to visualize opening and closing your hand (at this moment if she is still holding the ball) but visualize walking down a beautiful pathway - or something else that one enjoys - because at this time we need diversion. Sometimes there is confusion. Velda will look at me with a strange little smile - because all the ball will do is make strange little circles in the pan when she wants to move it from one pan to the other. But immediately we will intervene. No stress, no strain, no struggle. Relax, Divert, Breathe, Visualize. Take a break. The opposite of what you saw on the video.

Biometric Feedback Forty years ago I received a government grant to do a study on using biofeedback. We used an electroencephalograph to measure the biometric effects of meditation on the alpha and beta waves in brain. Like other experimenters, we had definite measurable results in being able to control the waves. Other experimenters showed that they were able to do weird things such as teach their subjects to raise the blood pressure on command in just one of their ears. It is using these demonstrated powers of the brain/mind that we expect to be able to teach it to move a limb through new neural pathways. How it Works! It isn't the muscles. Nothing needs to be massaged - or medicated. It isn't even the brain - because it too has alternate pathways. It is mind and only Mind. It is the Divine Dance - to the Divine Melody. The Song of God - being sung soul to soul. It isn't moving and counting balls - making marks upon the paper - clicking the stop watch - struggling and straining. But it is a struggle and strain for the helpers - and they don't stay around long enough - for me to teach them the Divine Melody - that they are to sing soul to soul. That what they are doing - is helping a soul to hear that Melody- to respond to that Mind that directs all. You don't have to believe any of these things that I am telling you - you only have to do them.

We had GOOD success even though we had some real cards stacked against us.

a. Most people will just give up on someone who is over eighty years old - but this just goes to show what can be accomplished even at that age. For all I know, it could be harder with a child - but possibly not, if it is like someone playing with them.

b. It is difficult when you have doctors, physical therapists and others opposed to what you are doing - but we had great support from many members of the family.

c. What may have been working most against us was that we had to remove the restraint most of the day. The stated goal of the process is for the person to wear it 90% of the time - but we couldn't do it while Velda was in the nursing home. With bathroom trips, going on walks with the walker, etc. she probably didn't have the restraint on more than five hours out of the day and not at all on weekends and so therefore only 15% instead of 90% of the time. Of course it was on during the times that she was doing the drills and that is what counts most.

d. Some people may read that and say - "Well, it just goes to show that you didn't know what you were doing." However, my advice is - don't let people stop you because they say you aren't a 'professional', don't have experience, or whatever. One just has to do the best they can do.

I do think it would be better to use the restraint full time during the 14 days and if your patient is in a nursing home - here is what you might do. You could have the nursing home supervisor look at this web page and if they would agree - you could conduct the ten days of therapy in a visiting room - and they might even agree to your patient wearing the restraint all the time. But this way you would have someone else doing the meals, bathroom trips and such and you wouldn't have to be taking the patient back and forth each day - and not having them at home or in your motel room if you have to travel to say where a parent is in a nursing home. This way you could relax in the evening and get a good nights sleep.

I have thought of telling people that they could do it in a motel room near to us and that I would try to help them - but I can tell you this, you need all the help that you can get. Just one person trying to do it will probably completely exhaust the patience of both you and the subject.

I really think it is too much for a couple to take on by themselves - say a wife, who is trying to look after her husband and they are living alone. I know that it is a terrible burden looking after a stroke victim and that such improvement as I have described would be a real boon - but in my opinion you need help.

The same is true of a mother who is looking after a family and who has perhaps a younger stroke victim in the family. Giving ten days of mCIT therapy to a single person is more than a full-time job for a single person. It is a full-time job for several people.

If there is some way that I can help you - write to me at:

[email protected]
with the subject line as: stroke
or I can be reached at (519) 925-6035